Health and Community Development in South Africa

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Course Information
Discipline(s): 
Sociology
Service Learning
Health Studies
Terms offered: 
Fall, Spring
Credits: 
3
Language of instruction: 
English
Contact Hours: 
45 in addition to 60 hours of service learning
Prerequisites: 

None.

 

Additional student cost: 

Occasional personal lunch costs (or pack your own at home) during fieldtrips.

Description: 

This course focuses on health-related issues confronting South Africa as well as their social and economic impacts. The course focuses on the main components of South African health care system and its transformation. Attention is paid to global and international health systems, trends in health care (high tech medicine and primary health care). Particular attention is paid to the demographics of HIV&AIDS, TB, chronic, non-communicable diseases and infectious diseases, as well as their prevention and treatment. The course includes visits and exposure to a variety of healthcare environments as well as community-based research and complementary medicine and their contributions to healthcare delivery in South Africa. The course is designed around an ‘all-in-one’ project where your research and your service learning are intertwined. Thus a research focus should be formulated early in the course so that your service learning provides an opportunity for fieldwork.

Attendance policy: 

Attendance of weekly lectures, field trips as well as completion of the 60 hours of service-learning is compulsory. Students who cannot attend weekly lectures and field trips due to legitimate reasons such as sickness, religious, or cultural grounds are required to notify the lecturer and present a sick certificate (if needed). 

Learning outcomes: 

By the end of the course, students will be able to:

  • Articulate links between Health, Inequality & Poverty, and Socio-economic Determinants of health.
  • Express links between HIV & AIDS, TB, chronic, non-communicable and infectious diseases and related healthcare issues and how it impacts on the current healthcare system.
  • Evaluate the policy landscape framing healthcare delivery in South Africa with particular reference to the district health system.
  • Identify the challenges in ensuring effective health care delivery and their impact on social and economic wellbeing in South Africa.
  • Analyze the historical evolution and transformation of the South African Health system from a fragmented, racist and disempowering to a developmental, participatory and inclusive system.
  • Examine development in South Africa using the lens of poverty, disease and lack of access.
Method of presentation: 

Learning will be facilitated through lectures, individual and group exercises, debates and discussions, student presentations, assignments, selected guests (practitioners), and fieldtrips. Lectures will focus on the theory and practice as it relates to global and South African health care systems, communicable & non communicable diseases and community development. The fieldtrips will further expose students to the applications of the concepts discussed during the lectures.  Students will also be given an opportunity to deepen their understanding of particular issues of interest to them through service-learning which would culminate into a research project.

 

Field study: 

SERVICE-LEARNING

All students participating in the course will be required to fulfil 60 hours of service-learning work at an agency that contributes to health and community development across the broader Cape Town area.  Students will be required to find time during the week or weekend to complete the 60 hours of service-learning over the semester.  Service learning is pre-arranged by IES Abroad and transportation is provided. The service done at the agency will be agreed upon between the agency and the student and must add value to the functioning of the organisation. This process will be closely supervised and monitored by the course convenor and faculty staff.

FIELD TRIPS

Note that for fieldtrips students are expected to bring a clipboard/notebook, pen/pencil, sunhat and suncream, and usually a light packed lunch and water/juice (when the fieldtrip runs over lunchtime).

  • Field Trip 1

    Healthcare in a rural community.

    Students will be transported to Genadendal, a rural community situated in the Threewaterskloof municipality. There they will experience health care at a community level, by accompanying the community health workers to the homes of clients. They will also be exposed to a community health centre, which is a primary level of care institution. Lastly, they will experience secondary level care, at Caledon Hospital, a rural hospital.
  • Field Trip 2

    HIV&AIDS Treatment

    A visit to Retreat Community Health Centre will introduce students to how HIV/AIDS is managed at a local community level.  
  • Field Trip 3

    A visit to Brooklyn Hospice where MDR-TB and XDR-TB will be put in context.

    Treatment outcomes of MDR-TB and XDR-TB will also be discussed. 

 

Required work and form of assessment: 
  • Assignment – 10%
  • Reaction Paper – 10%
  • Mid-Term Exam – 20%
  • Reflective Piece – 10%
  • Research Project – 40%
  • Symposium – 10%

Course Participation

Participation in all class discussions/debates and attendance for all site visits is mandatory. Students are expected to prepare for each class by doing the necessary reading and reflection, in addition to regularly checking notices on the VULA website.  All assignments must be submitted via Turnitin on the VULA platform and with a signed Plagiarism Declaration.

The University of Cape Town late assignment policy will apply and is as follows: All Assignments late by one day will receive a 5% penalty. For every day late thereafter 2% will be deducted and no assignments will be accepted later than 6 days after the deadline (this includes weekends).

ASSIGNMENT (10%)

Community based care.

This is a group assignment and it is linked to your fieldtrip to the Genadendal rural community. Community health care workers (home-based carers) have emerged as an important cadre of health care workers extending primary health care from the health care facilities to the homes in communities. During your fieldtrip, you will be introduced to the home-based care givers and experience their work in the rural community of Genadendal. Part of this programme and assignment will include an analysis of this model of health care, roles, challenges and sustainability of community-based care. More details about this assignment will be posted to Vula.

Due Date: This is to be submitted one week after the field trip.

REACTION PAPER (10%)

Two pages (800-1000 words). Each student presents one relevant paper ahead of a class session. This paper represents your contribution in class, i.e. through presentation and debate. A reaction paper is a response to writers to one or more texts you read. Having selected your theme(s) and readings to present on, you should come to class ready to answer questions from the class, the audience. You should also bring a list of questions (arising from the reading/paper) or issues they find peculiar and intriguing.

After the presentation students should document their work on the presentation in light of comments by the audience. You should demonstrate that the audience’s comments have been addressed in the final hand-in.

Due Date: Varies, depending on paper presented.

MIDTERM EXAMINATION (20%)

Four structured question requiring essay-type answers will be set for students to demonstrate understanding of theories, concepts and approaches to health and community development. The exam questions will also require students to apply concepts and approaches to practical situations and case studies as well as drawing from the fieldtrips experienced in the course. You will be examined on selected content covered in the course. The exam will be 1.5 hours.

Exam Date:Session 6

REFLECTIVE PIECE (10%)

This reflective piece constitutes a 3-4 page reflection of what you experienced, your expectations and your key learnings on the following three aspects of the course:

  1. Service-Learning
  2. Field Trips
  3. Research Project

Due Date: This is to be submitted on the day of the symposium.

Framework for Reflective Piece

Pre-conception/perceptions prior to arrival in Cape Town - Reflect on your personal conceptions (or misconceptions), what was known/understood concerning South Africa’s social, economic, political and cultural dynamics/context prior to arrival and how this (by the end of the course) would have been confirmed, reinforced, contradicted or furthered by your experience during the service-learning, field trips and research project.

Challenges and positive experiences, and lessons learned - Reflect on your personal experiences (the ‘highs’ and ‘lows’). This should highlight and explain why these are ‘highs’ and ‘lows’. You should explain lessons learnt from your challenges, successes and/or failures in your learning journey as it relates to the service-learning, fieldtrips and research project. These reflections should include your encounters with community(s), stakeholders as well and how you feel about the whole learning journey.

Engaged scholarship and individual skills development - Reflect on the theoretical and analytical concepts learnt in class, and how useful you think these theories and concepts were in making sense of what was happening in your service-learning, fieldwork and research project. You should also reflect on your research competence. What research, academic, social, and technical skills were you able to capitalize on? Reflect also on your experience of team/ stakeholder dynamics during your service-learning, fieldtrips and research project.

Recommendations - In light of the above, reflect on what you did best and give advice on how other students can benefit from your experience. Coupled with this, please consider areas you could improve upon.

RESEARCH PROJECT (40%)

This multi-component student research project combines your service-learning with your research. Your research project must consider an element of health and community development in South Africa tied to their service learning projects and material covered in lectures and fieldtrips. You will be expected to put forward a research question, devise a methodology to test their theory, describe their results and draw conclusions giving their view of the implications of their findings for health and community development in South Africa.

In groups, students will work on their individual projects together, putting together a preliminary “Presentation of Research Topic,” outlining the (1) Research Problem (aims) (2) Methodology (3) Literature Review (draft) (4) Timelines for Conducting Research. This initial presentation will not be marked and graded, but it will enable students to get feedback from the lecturer and comments from other students in the course. Students are also encouraged to consult with the lecturer throughout the research process. The presentation and continuous consultations with the lecturer enables each research project to be tracked, and completed on time. Students will have seven hours (7 hours) of supervision, consultations and feedback with the lecturer regarding their service-learning and research papers.

Due Date: This is to be submitted and presented on the day of the symposium.

Final Research Paper (70% of research project) (15 pages) (Font – Times New Roman 12; 1.5 line spacing) to support your movie clip (see below) must be submitted shortly after the symposium. The purpose of this document is to provide a hardcopy document which summarises your research project. This research report should include your Methodology and Literature Review either inserted directly, or revised in order to improve the flow of this final report.

  1. Introduction (background to the topic as well as context)
  2. Research Aims (which includes project aim, and rationale for project choice, as well as supporting academic framework)
  3. Methodology (outlining planning process, challenges dealt with, participation with local community, data collection and analysis)
  4. Findings and Discussion (outlining what ultimately was achieved, and where you took the initiative and/or went beyond the call of "duty".
  5. Recommendations and Conclusion (describing what still needs to be done, and how the next student could take the project to the next level).
  6. Appendices (additional information that will be useful for the student picking up this project in the following semester). Refer to Appendix C for the Research Paper marking rubric.

A Documentary/video (30% of research project) must be a “stand alone” version of your research paper. This 3 minute movie clip should demonstrate your research project, as well as reflect your collective learning in this course, and will draw on what you have learnt in class as well as what you have seen on field trips and have experienced in your service learning work.



The movie clip will be marked during the Symposium, based on elements of the project that should be clearly discernible from watching the video. As such, it will be marked in a manner more or less similar to your research paper, i.e. with additional considerations, namely:

  1.  Research project content (introduction and project aim clearly articulated; methodology demonstrated; evidence of how academic literature been integrated into the project design)
  2. Research project implementation (Evidence of forward planning; engaged with local community; thought out of the box - showed initiative; illustrated how challenges were dealt with).
  3. Video production (Visuals align with content; Sound appropriate for content, adds to video message, not distracting; content communicated through video production).
  4. Personal presentation and questions and answer session (Responding to questions showed satisfactory grasp of content and awareness methodology; Body language and appearance shows confidence in presenting, makes eye contact with audience, no distracting body movements.

SYMPOSIUM (10%)

The symposium presents an opportunity for all IES Abroad students to come together to learn more about each other’s research project and service-learning during the semester. Structure your presentation bearing in mind that the course combines your service-learning with your research project. Generally students will undertake service learning and research work in teams, and will present their research in the same teams. Each team will get 20 minutes to do a short power point presentation. Each team member should present, so it is up to the team to allocate sections of the presentation amongst group members.

If individual students undertake research and service-learning, then each student will be allocated 5 minutes to do a short power point presentation.

Students will be given an opportunity to present the 3 minute documentary/video clip, and there are 2 additional minutes, for questions and responses. Marks will be allocated for your documentary/video, as well your response to questions from the audience. You are encouraged to be creative in putting together the presentation.  Credit will be given to students who present their work holistically using literature, developing an academic argument and with innovation.

content: 

SESSIONS

CONTENT

READINGS & PREPARATION

Field Trip 1

Healthcare in a rural community

(See field trip description in field trip section)

Session 1: Combined IES Lecture: Research

Introduction to Research

  • Research concepts and terminology
  • Research methods
  • Research processes
  • Cooper, D. Wickham, S & Bailey, T (1997). The Research Journey Workbook: Research & Academic Development

Session 2: Introduction to course

Class 1: Course Elements

  • Learning objectives and assessment
  • Synergies between service learning, field trips, the research paper, and lectures
  • Administration and support

Class 2:

  • Introducing the key concepts
  • Health & its determinants
  • Comprehensive primary healthcare
  • V Zweigenthal, T Puoane, L Reynolds et al. 2009. Primary Health Care - Fresh Perspectives. Pearson Prentice Hall

Session 3: Healthcare systems

  • Global healthcare systems
  • South African healthcare system
  • Primary, secondary, and tertiary health institutions
  • Mark Heywood & John Shija A Global Framework Convention on Health - Would it Help Developing Countries to Fulfill their Duties on the Right to Health? A South African Perspective
  • Yamin (2014). Promoting Equity in Health: What Role for Courts? Health and Human Rights Journal, December 2014, Number 2, Volume 16

Session 4: Healthcare in SA

Healthcare in South Africa : 

  • Health for all
  • History of healthcare in RSA
  • Democracy and changes in healthcare
  • National health insurance
  • Benatar S (2013).The challenges of health disparities in South Africa. S Afr Med J 2013;103(3):154-155. DOI:10.7196/SAMJ.6622
  • Mayosi & Benatar (2014) Health and Health Care in South Africa — 20 Years after Mandela. New England j med 371;14 nejm.org October 2, 2014
  • Matsotso MP, Fryatt R (2013). National Health Insurance: The first 18 months. In Padarath A, English R, editors. South African Health Review 2012/13. Durban: Health Systems Trust; 2013.

Session 5: The HIV/AIDS pandemic 

  • Status of HIV globally:
  • History/ epidemiology of HIV&AIDS
  • Trends and treatment options
  • The impact of HIV&AIDS on the South African healthcare system:
  • Thabo Mbeki and HIV&AIDS
  • Impact of HIV&AIDS on RSA  
  • WHO & UNAIDS (2013). Core Epidemiology Slides.
  • WHO (2011). Global health sector strategy on HIV/AIDS 2011-2015.
  • WHO (2013). Global report: UNAIDS report on the global AIDS epidemic 2013.
  • WHO (2014). Global AIDS response progress reporting 2014: construction of core indicators for monitoring the 2011 UN political declaration on HIV/AIDS.
  • Ndlovu et al. (2013).Trends in national and Provincial health and HIV/AIDS Budgeting and spending in South Africa. CEGAA Occasional Paper 2013
  • UNAIDS (2015). Treatment 2015
  • UNAIDS (2013). Chapter 9: HIV treatment and health care in  Judging the epidemic.  A judicial handbook on HIV, human rights and the law. 
  • Movie: Yesterday

Field Trip 2

HIV/AIDS Treatment

(See field trip description in field trip section)

Session 6

Midterm Examination

 

Session 7: The politics of TB in SA 

  • TB- A Disease of Poverty
  • Epidemiology
  • Treatment of TB and MDR-TB/XDR-TB
  • WHO 2013 Global Tuberculosis Report 2013 Case Studies

Field Trip 3

TB in Context

 

Session 8: Community Development in SA 

A Critical Look at Development Policy & Community Development in South Africa

  • The post-apartheid South African state’s policy response to poverty and inequality
  • Ways in which national policies have repercussions for local development
  • Critique of policies and practices of the post-apartheid state
  • Challenges the national government (and its local government) faces in its effort to create a better and dignified life for all citizens
  • Mogale T.M. (2005). Local governance and poverty reduction in South Africa. Progress in Development Studies, 5 (2), pp.135-143.
  • South Africa National Development Plan (2011)  http://www.info.gov.za/issues/national-development-plan/
  • Winkler T. (2008). When God and Poverty Collide: Exploring the Myths of Faith –sponsored community development. Urban Studies 45(10) 2099-2116
  • Carter M. & May J. (1999). Poverty, Livelihood and Class in Rural South Africa. World Development, 27 (1) pp. 1-20
  • Sseguya, H., Mazur, R. E., Njuki, J. M., & Owusu, F. Y. (2013). Determinants of participation and leadership in food security groups in Southeast Uganda: Implications for development programs and policies. Journal of Rural and Community Development, 8(1), 77-97.

Session 9: Non-communicable Diseases in SA

  • The rise of non-communicable diseases in RSA
  • Impact on the healthcare system
  • Impact on communities
  • BM Mayosi, AJ Flisher, UG Lalloo, F Sitas, SM Tollman (2009) The burden of non-communicable diseases in South Africa. The Lancet, 2009
  • M. Schneider et al (2009). Poverty and non-communicable diseases in South Africa. Scandinavian Journal of Public Health 2009; 00: 1-11
  • Dalal S et al. (2011). Non-communicable diseases in sub-Saharan Africa: what we know now. International Journal of Epidemiology, Volume 40, Issue 4. 885-901.

Session 10: Role of Civil Society,  Complimentary & Traditional Medicine in SA Healthcare 

Non-governmental organizations and traditional and complementary medicine and their contributions to healthcare delivery in South Africa
  • Richter M (2003). Traditional Medicines and Traditional Healers in South Africa
  • WHO Traditional Medicine Strategy 2002-2005
  • Peltzer et al (2008). Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa BMC Public Health 2008, 8:255. Doi:10.1186/1471-2458-8-255
  • N Nxumalo, O Alaba, B Harris (2011) Utilization of traditional healers in South Africa and costs to patients: findings from a national household survey. Journal of Public Health 2011

Session 11: Community Development Approaches

Class 1: Bottom-up and Top-down Approaches to Community Development

  • State-led approaches to development (top-down) vs community-led (bottom-up (participatory)
  • Possibility of middle ground between state-led and community-driven development
  • Recapping the concept of community participation, and how it relates to the two development approaches

Class 2: Case Studies

  • Consideration of the pros and cons of each approach using a South African case study(s).
  • Larrison, C.R. (1999). Comparison of Top-down and Bottom-up Community Development Interventions in Rural Mexico: Practical and Theoretical Implications for Community Development Programs. University of Georgia, United States of America (USA)
  • Mitlin, D & Thompson, J (1995). Participatory Approaches in Urban Areas: Strengthening Civil Society or Reinforcing the Status Quo? Environment and Urbanization, Vol. 7, No. 1, PP. 231-250 (Focus mainly on the South African Case Study)
  • Landman, K (2010). A Home Close to Opportunities in South Africa: Top Down Vision or Bottom up Demand? Journal Home Vol 56 , pp. 8 - 17
Session 12

Class 1: Understanding Healthcare and Community Development in RSA

  • What have we learned?
  • Student reflections
  • Student presentations

Class 2: Summary of all lectures

  • Review of lectures by revisiting and clarifying key concepts and theories as well as connections between them
  • Van Rensburg, HJ (2012). Health and Health Care in South Africa

IES Symposium

Final Research Report and Portfolio of Evidence is due

  • Deliver final presentation and complete course evaluation

 

Required readings: 
  • A National Health Plan for South Africa. African National Congress (1994).
  • Benatar S (2013).The challenges of health disparities in South Africa. S Afr Med J 2013;103(3):154-155. DOI:10.7196/SAMJ.6622
  • BM Mayosi, AJ Flisher, UG Lalloo, F Sitas, SM Tollman (2009) The burden of non-communicable diseases in South Africa. The Lancet, 2009.
  • Carter M. & May J. (1999). Poverty, Livelihood and Class in Rural South Africa. World Development, 27 (1) pp. 1-20
  • Cooper, D. Wickham, S & Bailey, T (1997). The Research Journey Workbook: Research & Academic Development
  • Dalal S et al. (2011). Non-communicable diseases in sub-Saharan Africa: what we know now. International Journal of Epidemiology, Volume 40, Issue 4. 885-901
  • The Equity Gauge - Concepts, Principles, and Guidelines. The Global Equity Gauge Alliance (2003).
  • Intersectoral Action for Health – A Cornerstone for Health-for-All in the 21st Century. WHO (1997).
  • Landman, K (2010). A Home Close to Opportunities in South Africa: Top Down Vision or Bottom up Demand? Journal Home Vol 56 , pp. 8 - 17
  • Larrison, C.R. (1999). Comparison of Top-down and Bottom-up Community Development Interventions in Rural Mexico: Practical and Theoretical Implications for Community Development Programs. University of Georgia, United States of America (USA)
  • M Schneider et al (2009). Poverty and non-communicable diseases in South Africa. Scandinavian Journal of Public Health 2009; 00: 1-11
  • Mark Heywood & John Shija A Global Framework Convention on Health - Would it Help Developing Countries to Fulfill their Duties on the Right to Health? A South African Perspective
  • Matsotso MP, Fryatt R (2013). National Health Insurance: The first 18 months. In Padarath A, English R, editors. South African Health Review 2012/13. Durban: Health Systems Trust; 2013.
  • Mayosi & Benatar (2014) Health and Health Care in South Africa — 20 Years after Mandela. New England j med 371;14 nejm.org October 2, 2014
  • Millennium Project Report to the UN Secretary-General: Investing in Development – A Practical Plan to Achieve the Millennium Development Goals – Chapter 10: Africa’s Special Needs. United Nations Development Programme (2005).
  • Mitlin, D & Thompson, J (1995). Participatory Approaches in Urban Areas: Strengthening Civil Society or Reinforcing the Status Quo? Environment and Urbanization, Vol. 7, No. 1, PP. 231-250 (Focus mainly on the South African Case Study)
  • Mogale T.M. (2005). Local governance and poverty reduction in South Africa. Progress in Development Studies, 5 (2), pp.135-143.
  • N Nxumalo, O Alaba, B Harris (2011). Utilization of traditional healers in South Africa and costs to patients: findings from a national household survey. Journal of Public Health 2011
  • Ndlovu et al. (2013).Trends in national and Provincial health and HIV/AIDS Budgeting and spending in South Africa. CEGAA Occasional Paper 2013
  • Peltzer et al (2008). Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa BMC Public Health 2008, 8:255 doi: 10.1186/1471-2458-8-255
  • Richter M (2003). Traditional Medicines and Traditional Healers in South Africa
  • Sseguya, H., Mazur, R. E., Njuki, J. M., & Owusu, F. Y. (2013). Determinants of participation and leadership in food security groups in Southeast Uganda: Implications for development programs and policies. Journal of Rural and Community Development, 8(1), 77-97.
  • Steinberg, J. 2007. Three-Letter Plague. Jonathan Ball Publishers
  • South Africa National Development Plan (2011)  http://www.info.gov.za/issues/national-development-plan/
  • UNAIDS (2015). Treatment 2015
  • UNAIDS (2013). Chapter 9: HIV treatment and health care in  Judging the epidemic.  A judicial handbook on HIV, human rights and the law. 
  • UN political declaration on HIV/AIDS.
  • V Zweigenthal, T Puoane, L Reynolds et al. 2009. Primary Health Care – Fresh Perspectives.  Pearson Prentice Hall
  • Van Rensburg, HJ (2012). Health and Health Care in South Africa
  • WHO (2011). Global health sector strategy on HIV/AIDS 2011-2015.
  • WHO (2013). Global report: UNAIDS report on the global AIDS epidemic 2013.
  • WHO (2013). Global tuberculosis report 2013: Case studies
  • WHO (2014). Global AIDS response progress reporting 2014: construction of core indicators for monitoring the 2011
  • WHO & UNAIDS (2013). Core Epidemiology Slides.
  • WHO Traditional Medicine Strategy 2002-2005
  • Winkler T. (2008). When God and Poverty Collide: Exploring the Myths of Faith –sponsored community development. Urban Studies 45(10) 2099-2116
  • Yamin (2014). Promoting Equity in Health: What Role for Courts?  Health and Human Rights Journal, December 2014, Number 2,  Volume 16