Cui bono?: a capabilities approach to understanding HIV prevention and treatment for pregnant women and children in South Africa
Year: 2010
Type: dissertation
Abstract: The global health revolution of the last 50 years has generated significant health gains \nin terms of increased life expectancy and reduced maternal mortality. South Africa, \nan upper middle income country, has performed poorly along the same development \nindicators. Development gains for women and children won over two decades \nare now being reversed, largely due to HIV/AIDS. This is in spite of the evidence \nthat lifesaving antiretroviral medication can prolong life and enhance quality of \nlife. Using a joint capabilities and health equity lens, this thesis seeks to understand \na critical development problem in South Africa – premature mortality in pregnant \nwomen and children attributed to HIV – an infectious disease that is both preventable \nand treatable. \nThe research identifies key barriers faced by pregnant and postnatal women with \nHIV who seek (freely available) access to PMTCT (prevention of mother to child HIV \ntransmission) and ART (antiretroviral therapy) programmes in the public health sector. \nThe study considers whether disparities in, and missed opportunities for, preventing \nand treating HIV in these population groups comprise avoidable, systematic and \nunfair health inequities. The implications for the capabilities of women and children \nwith HIV in this country are also explored. \nQualitative research methods are employed to investigate the research concern. \nSemi-structured interviews with 83 women comprise the mainstay of the field \nresearch. Interviews with 37 caregivers of children with HIV, together with patient \nfiles and interviews with key informants, supplement the data collection. Research \nwas undertaken in two sites in two provinces: Eastern Cape and Gauteng. Each site \nconstitutes a bounded case study. A rural-urban perspective is put forward – with \nattention to equity considerations in access to maternal-child HIV services. \nThe study evinces a host of avoidable factors in the operational delivery of ART/PMTCT, \nalong a range of intervention points in the continuum of care: including the antenatal, \nlabour, postnatal and pediatric wards. While some of these factors are influenced \nby individual behaviour, the vast majority are directly linked to the health system \n– illuminating the ways in which the health system serves as a social determinant of \nhealth (SDH), and often restricting, constraining, and ironically, preventing people \nfrom obtaining the interventions and information they need to improve their health. iii \nBy connecting the empirical findings related to ART/PMTCT within the health system \nto the capabilities and health equity literatures, an understanding of disparities in \naccess to, and delivery of, such services – and their importance in shaping health, \ndevelopment and health outcomes of these population groups – becomes clearer. As a \nconsequence, strengthening the public health system is a necessary first step to ensuring \nat least some of the minimum conditions that allow people to be healthy. As an entry \npoint, there is great scope for systems’ interventions that would address the shortfall \nin health for black South Africans and deprivations in their health capability. \nAt the same time, the research reveals that – owing to the contribution of social \ndeterminants of health (e.g., factors that impact on health such as living and working \nconditions, but lie outside the realm of healthcare) to health status: good health is not \nachieved solely by access to and provision of good healthcare. This reality underscores \nthe importance of health as a central capability; and good health as a normative social \ngoal. In the capability view, the moral concern for state and society is the reduced \ncapability of individuals due to health inequities that are socially-constructed, and in \nturn, changeable. Recommendations to address modifiable factors related to effective \nART/PMTCT provision in these facilities are put forward, with a set of suggestions \nfor future research in maternal, child and women’s health in South Africa.
Author: Courtenay Sprague
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W93681565