Fiscal federalism an equity in the financing of primary health care: The case of South Africa

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dc.contributor.advisorMcIntyre, Dien_ZA
dc.contributor.advisorThomas, Stephenen_ZA
dc.contributor.authorOkorafor, Okore Apiaen_ZA
dc.date.accessioned2014-11-08T18:05:08Z
dc.date.available2014-11-08T18:05:08Z
dc.date.issued2009en_ZA
dc.descriptionIncludes bibliographical references.en_ZA
dc.description.abstractThis thesis investigates the implications of fiscal federalism on the equitable distribution of primary health care resources in South Africa. The study evaluates the processes and criteria for intergovernmental and sector budgeting, the influence of key stakeholders, community involvement in PHC budgeting, and policy objectives of the health sector to assess how they impact on the realisation of an equitable distribution of PHC resources. A combination of qualitative and quantitative analyses was employed in the study. Quantitative analysis of health expenditure and health need data was used to assess whether the distribution of PHC resources has become more or less equitable. Health districts were the units of analysis. Deprivation indices were generated using principal components analysis for each district from demographic and socio-economic variables. The deprivation index was used as a proxy for relative need at the level of districts, and was compared with non-hospital PHC per capita expenditure using regression analysis. This analysis was carried out for per capita PHC from 2001 to 2007. Data on the process for intergovernmental fiscal arrangements and budgeting for health was collected through review of government publications and interviews with government officials. These were analysed thematically. Literature on the subject predicts that if lower levels of government have considerable autonomy in determining primary health care allocations, there is a greater scope for inequities in the distribution of primary health care resources. However, the results of the study are contrary to expectations. Although, the introduction of fiscal federalism in South Africa created an additional constraint to achieving a more equitable distribution of PHC resources, recent trends in primary health care allocations are more equitable than in previous years. A growing public sector budget, consistent increases in health sector allocations, and overwhelming political support for equity in South Africa have been the key reasons for the shifts towards a more equitable distribution of primary health care resources. These findings form the main contribution to the literature on the subject.en_ZA
dc.identifier.apacitationOkorafor, O. A. (2009). <i>Fiscal federalism an equity in the financing of primary health care: The case of South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit. Retrieved from http://hdl.handle.net/11427/9414en_ZA
dc.identifier.chicagocitationOkorafor, Okore Apia. <i>"Fiscal federalism an equity in the financing of primary health care: The case of South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2009. http://hdl.handle.net/11427/9414en_ZA
dc.identifier.citationOkorafor, O. 2009. Fiscal federalism an equity in the financing of primary health care: The case of South Africa. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Okorafor, Okore Apia AB - This thesis investigates the implications of fiscal federalism on the equitable distribution of primary health care resources in South Africa. The study evaluates the processes and criteria for intergovernmental and sector budgeting, the influence of key stakeholders, community involvement in PHC budgeting, and policy objectives of the health sector to assess how they impact on the realisation of an equitable distribution of PHC resources. A combination of qualitative and quantitative analyses was employed in the study. Quantitative analysis of health expenditure and health need data was used to assess whether the distribution of PHC resources has become more or less equitable. Health districts were the units of analysis. Deprivation indices were generated using principal components analysis for each district from demographic and socio-economic variables. The deprivation index was used as a proxy for relative need at the level of districts, and was compared with non-hospital PHC per capita expenditure using regression analysis. This analysis was carried out for per capita PHC from 2001 to 2007. Data on the process for intergovernmental fiscal arrangements and budgeting for health was collected through review of government publications and interviews with government officials. These were analysed thematically. Literature on the subject predicts that if lower levels of government have considerable autonomy in determining primary health care allocations, there is a greater scope for inequities in the distribution of primary health care resources. However, the results of the study are contrary to expectations. Although, the introduction of fiscal federalism in South Africa created an additional constraint to achieving a more equitable distribution of PHC resources, recent trends in primary health care allocations are more equitable than in previous years. A growing public sector budget, consistent increases in health sector allocations, and overwhelming political support for equity in South Africa have been the key reasons for the shifts towards a more equitable distribution of primary health care resources. These findings form the main contribution to the literature on the subject. DA - 2009 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Fiscal federalism an equity in the financing of primary health care: The case of South Africa TI - Fiscal federalism an equity in the financing of primary health care: The case of South Africa UR - http://hdl.handle.net/11427/9414 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/9414
dc.identifier.vancouvercitationOkorafor OA. Fiscal federalism an equity in the financing of primary health care: The case of South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2009 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/9414en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherHealth Economicsen_ZA
dc.titleFiscal federalism an equity in the financing of primary health care: The case of South Africaen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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