Cui bono?: a capabilities approach to understanding HIV prevention and treatment for pregnant women and children in South Africa

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dc.contributor.author Sprague, Courtenay
dc.date.accessioned 2010-06-29T06:52:34Z
dc.date.available 2010-06-29T06:52:34Z
dc.date.issued 2010-06-29T06:52:34Z
dc.identifier.uri http://hdl.handle.net/10539/8234
dc.description PhD, Faculty of Law, Commerce and Management, University of the Witwatersrand, 2009. en_US
dc.description.abstract The global health revolution of the last 50 years has generated significant health gains in terms of increased life expectancy and reduced maternal mortality. South Africa, an upper middle income country, has performed poorly along the same development indicators. Development gains for women and children won over two decades are now being reversed, largely due to HIV/AIDS. This is in spite of the evidence that lifesaving antiretroviral medication can prolong life and enhance quality of life. Using a joint capabilities and health equity lens, this thesis seeks to understand a critical development problem in South Africa – premature mortality in pregnant women and children attributed to HIV – an infectious disease that is both preventable and treatable. The research identifies key barriers faced by pregnant and postnatal women with HIV who seek (freely available) access to PMTCT (prevention of mother to child HIV transmission) and ART (antiretroviral therapy) programmes in the public health sector. The study considers whether disparities in, and missed opportunities for, preventing and treating HIV in these population groups comprise avoidable, systematic and unfair health inequities. The implications for the capabilities of women and children with HIV in this country are also explored. Qualitative research methods are employed to investigate the research concern. Semi-structured interviews with 83 women comprise the mainstay of the field research. Interviews with 37 caregivers of children with HIV, together with patient files and interviews with key informants, supplement the data collection. Research was undertaken in two sites in two provinces: Eastern Cape and Gauteng. Each site constitutes a bounded case study. A rural-urban perspective is put forward – with attention to equity considerations in access to maternal-child HIV services. The study evinces a host of avoidable factors in the operational delivery of ART/PMTCT, along a range of intervention points in the continuum of care: including the antenatal, labour, postnatal and pediatric wards. While some of these factors are influenced by individual behaviour, the vast majority are directly linked to the health system – illuminating the ways in which the health system serves as a social determinant of health (SDH), and often restricting, constraining, and ironically, preventing people from obtaining the interventions and information they need to improve their health. iii By connecting the empirical findings related to ART/PMTCT within the health system to the capabilities and health equity literatures, an understanding of disparities in access to, and delivery of, such services – and their importance in shaping health, development and health outcomes of these population groups – becomes clearer. As a consequence, strengthening the public health system is a necessary first step to ensuring at least some of the minimum conditions that allow people to be healthy. As an entry point, there is great scope for systems’ interventions that would address the shortfall in health for black South Africans and deprivations in their health capability. At the same time, the research reveals that – owing to the contribution of social determinants of health (e.g., factors that impact on health such as living and working conditions, but lie outside the realm of healthcare) to health status: good health is not achieved solely by access to and provision of good healthcare. This reality underscores the importance of health as a central capability; and good health as a normative social goal. In the capability view, the moral concern for state and society is the reduced capability of individuals due to health inequities that are socially-constructed, and in turn, changeable. Recommendations to address modifiable factors related to effective ART/PMTCT provision in these facilities are put forward, with a set of suggestions for future research in maternal, child and women’s health in South Africa. en_US
dc.language.iso en en_US
dc.subject HIV/AIDS en_US
dc.subject women en_US
dc.subject children en_US
dc.subject prevention en_US
dc.title Cui bono?: a capabilities approach to understanding HIV prevention and treatment for pregnant women and children in South Africa en_US
dc.type Thesis en_US


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    Thesis (Ph.D.)--University of the Witwatersrand, 1972.

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