Browsing by Author "Booysen, Frikkie"

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    Absorptive capacity to finance HIV/AIDS treatment in South Africa: Where are the bottlenecks?
    (2010) Irurzun Lopez, Maria Teresa; Sinanovic, Edina; Booysen, Frikkie
    This research investigates absorptive capacity in South Africa's public health sector in relation to scaling up financing for HIV/AIDS treatment. The thesis constructs a conceptual framework, which follows the flow of public funding for HIV/AIDS treatment. The study combines a quantitative budget analysis, which looks at expenditure and spending patterns, with qualitative in-depth interviews with key stakeholders exploring causes and consequences, which are the main pillar of the primary research. The study applies the conceptual framework nationally, as well as in the Free State and Western Cape provinces. The contributions of the thesis are two-fold: At the conceptual level, the study defines and constructs an analytical framework of absorptive capacity and related bottlenecks in the context of funding for HIV/AIDS treatment in the public health sector. It identifies five major areas where bottlenecks may arise: financial, human, infrastructural, institutional (within the health system) and structural (outside the health system). At the empirical level, the study assesses and compares absorptive capacity and major bottlenecks encountered nationally and in the Free State and Western Cape provinces in respect of the public sector funding for the HIV/AIDS treatment programme. The results confirm that absorptive capacity is not merely about spending funding. Spending should not compromise other programs or elements of the public health system, and it should be efficient, equitable and sustainable. The findings show that South Africa's absorptive capacity was constrained by several obstacles, such as poor practices and a shortage of human resources, insufficient financial capacity and demanding requirements of conditional funding, inadequate infrastructure, and inadequate national leadership. To overcome these obstacles, the mere injection of even more funding would be an insufficient response. Consequently, the study indicates which other reforms are required, including: further integrating antiretroviral treatment services within the public health structures; further decentralising antiretroviral treatment towards primary health care; task shifting; iii balancing the conditional grant and equitable share; and enhancing coordination between the National and Provincial Departments of Health and with Treasury.
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    Determinants of the choice of health care facility utilised by individuals in HIV/AIDS-affected households in the Free State province of South Africa
    (2004) Visser, Martine; Booysen, Frikkie
    This paper analyses differences in the choice of health care facility by individuals in HIV/AIDS-affected households in the Free State province of South Africa. Illness is more prevalent and severe amongst poorer affected households. The probability that individuals seek private versus public health care conditional on individual and household specific socio-economic variables is investigated. Significant determinants of choice of health care facility are income, severity of illness, the burden of illness and death in the household, the number of people in the household with access to medical aid, and secondary education. The demand for private health care over public health care is sensitive to income, with those from the lowest income quintile on average being less likely to switch to private health care than those in the highest income quintile. The planned roll-out of anti-retroviral treatment in public health care facilities in South Africa therefore will be crucial in enabling infected persons from poor households access to treatment. The provision of free treatment at public facilities may also see health care shift from private to public providers in the longer term.
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    Highly active antiretroviral treatment and health related quality of life in South African adults with human immunodeficiency virus infection: A cross-sectional analytical study
    (BioMed Central Ltd, 2007) Louwagie, Goedele; Bachmann, Max; Meyer, Kobus; Booysen, Frikkie; Fairall, Lara; Heunis, Christo
    BACKGROUND:Health Related Quality of Life (HRQoL) is an important outcome in times of Highly Active Antiretroviral Treatment (HAART). We compared the HRQoL of HIV positive patients receiving HAART with those awaiting treatment in public sector facilities in the Free State province in South Africa. METHODS: A stratified random sample of 371 patients receiving or awaiting HAART were interviewed and the EuroQol-profile, EuroQol-index and Visual Analogue Scale (VAS) were compared. Independent associations between these outcomes and HAART, socio-demographic, clinical and health service variables were estimated using linear and ordinal logistic regression, adjusted for intra-clinic clustering of outcomes. RESULTS: Patients receiving HAART reported better HRQoL for 3 of the 5 EuroQol-dimensions, for the VAS score and for the EuroQol index in bivariable analysis. They had a higher mean EuroQol index (0.11 difference, 95% confidence interval [CI] 0.04; 0.23), and were more likely to have a higher index (odds ratio 1.9, 95% CI 1.1; 1.3), compared to those awaiting HAART, in multivariate analysis. Higher mean VAS scores were reported for patients who were receiving HAART (6.5 difference, 95% CI 1.3; 11.7), were employed (9.1, 95% CI 4.3; 13.7) or were female (4.7, 95% CI 0.79; 8.5). CONCLUSION: HAART was associated with improved HRQoL in patients enrolled in a public sector treatment program in South Africa. Our finding that the EuroQol instrument was sensitive to HAART supports its use in future evaluation of HIV/AIDS care in South Africa. Longitudinal studies are needed to evaluate changes in individuals' HRQoL.