CSSR/SALDRU Working Papers

We examine patterns of health seeking behaviour prior to death among 1282 individuals who lived in the Umkhanyakude District of Northern KwaZulu-Natal. Information on the health care choices of these individuals, who died between January 2003 and July 2004, was gathered after their deaths from their primary care-givers. We examine choices made concerning public and private medicine, western and traditional medicine, and non-prescribed self-medication. We find that virtually all adults who were ill prior to death sought treatment from a Western medical provider, visiting either a public clinic or a private doctor. In this district, which is predominantly poor, ninety percent of adults who sought treatment from a public clinic also visited a private doctor. Fifty percent also sought treatment from a traditional healer, suggesting that traditional medicine is seen as a complement to, rather than a substitute for, Western care. Better educated people who were ill for less than a month before dying were significantly more likely to visit a private doctor, while those least well educated were more likely to visit a traditional healer. Controlling for length of illness, better educated and wealthier people sought care from a greater range of providers, and spent significantly more on their treatment.

The impact of parental death on school enrollment and achievement: Longitudinal evidence from South Africa

This qualitative micro study was conducted in the Metropole of Cape Town, the third largest metropole in South Africa during 2002. The study must be seen in relation to the Cape Area Panel Study (CAPS) that was conducted in June 2002. CAPS is planned as a longitudinal data collection project aimed at the youth in the Cape Metropole. The panel study broadly aims to supplement existing data sets like the Census, October Household Survey [OHS], Labour Force Survey [LFS] in particular with longitudinal and qualitative data addressing areas not necessarily done by national surveys. It anticipates uncovering determinants of schooling, unemployment and earnings of young adults and youth in this part of the country. Adolescent childbearing is common in South Africa as demonstrated by the 1998 South Africa Demographic and Health Survey, where by the age of 19 years, 30 percent of teenage females have had a child, 35 percent have been pregnant and the majority of teenage childbearing is outside of marriage. [Department of Health 1999]  Given the high prevalence of pregnancy and unmarried childbearing among adolescent females, it becomes important to understand the degree to which young people themselves understand how pregnancy and childbearing in adolescence delay or disrupt other life course events such as school completion or entering into marriage or cohabitation. Drawing on focus group discussion data from teenagers in Cape Town on normatively appropriate sequences, we note the degree to which the actual ways teenage males and females move through adolescence depart from the normative sequences.

This paper investigates changes in and patterns of income inequality in South Africa during the post-apartheid period 1994 to 2004. While findings show a rapidly growing high-income African population (a trend that began before 1994 and continued thereafter) as well as rising real wages for workers in formal employment, overall levels of income inequality have not been declining This is due to rising unemployment and a small informal sector that have therefore left unchanged South Africa's high level of income inequality. If anything, overall inequality has worsened. Inter-racial inequality has decreased while intra-racial inequality has increased. Opportunities have improved for some African people in South Africa, but not for all: a lack of human and social capital leaves many with little chance of rising out of poverty; AIDS-related mortality and morbidity are likely to exacerbate stratification and further increase inequality.

Sustainable poverty reduction requires that poor households effectively manage risk. The absence of basic financial services is a major obstacle to poverty reduction in South Africa. This paper reviews available South African literature on utilisation of formal and informal risk management instruments. The centrality of income in accessing the complementary bundle of formal financial services excludes households in the lower deciles from formal financial services. Rural households and households without formally employed household members are also denied access. Strong complementarities with informal channels of finance mean that these same households have limited access to even informal financial services. Promoting the use of savings accounts in pension and social grant payouts and the growth of village banks have been suggested as means to increase formal access for the poor.

We begin by summarising the literature that has assessed medium-run changes in poverty and inequality in South Africa using census data. According to this literature, over the 1996 to 2001 period both poverty and inequality increased. In this paper we assesses the robustness of these results to the large percentage of individuals and households in both censuses for whom personal income data is missing and to the fact that personal income is collected in income bands rather than as point estimates. First, we use a sequential regression multiple imputation approach to impute missing values for the 2001 census data. Relative to the existing literature, the imputation results lead to estimates of mean income and inequality (as measured by the Gini coefficient) that are higher and estimates of poverty that are lower. This is true even accounting for the wider confidence intervals that arise from the uncertainty that the imputations bring into the estimation process.  Next we go on to assess the influence of dubious zero values by setting them to missing and re-doing the multiple imputation process.   This increases the uncertainty associated with the imputation process as reflected in wider confidence intervals on all estimates and only the Gini coefficient is significantly different from the first set of estimated parameters. The final imputation exercise assesses the sensitivity of results to the practice of taking personal incomes recorded in bands and attributing band midpoints to them.  We impute an alternative set of intra-band point incomes by replicating the intra-band empirical distribution of personal incomes from a national income and expenditure survey undertaken in the year before each census. Using the empirical distributions increases estimated inequality although the differences are relatively small. We finish our empirical work with a discussion of provincial poverty shares as a policy relevant illustration of the importance of dealing with missing values. Overall our results for 1996 and 2001 confirm the major findings from the existing literature while generating more reliable confidence intervals for the key parameter of interest than are available elsewhere.

The Links Between Migration, Poverty and Health: Evidence From Khayelitsha and Mitchell's Plain

We investigate the time allocation decisions by South African learners using the South African Time Use Survey. We show that punctuality appears to be a problem with around 20% of all learners seeming to arrive late. Punctuality and absenteeism seem to be problems disproportionately among poor learners. Overall time devoted to schooling and homework does not show a consistent income gradient. Poor learners, however, spend considerable time each day on chores. The distribution of this additional work falls disproportionately on girls. Some of the findings can be easily explained in terms of a simple human capital production framework, but some of the social constraints seem to require a broader framework in which choices by some individuals create externalities for others.

While in many African countries, open unemployment is largely confined to urban areas and thus overall rates are quite low, in South Africa (and a few other Southern African countries), open unemployment rates hover around 30%, with rural unemployment rates being even higher than that.  This occurs despite the near complete absence of an unemployment insurance system and little labour market regulation that applies to rural labour markets.  This paper examines how unemployment can persist without support from unemployment compensation.  Analysing household surveys from 1993, 1995, and 1998, we find that the household formation response of the unemployed is the critical way in which the unemployed assure access to resources.  In particular, unemployment delays the setting up of an individual household by young persons, in some cases by decades.  It also leads to the dissolution of existing households and a return of constituent members to parents and other relatives and friends.  Access to state transfers (in particular, non-contributory old age pensions) increases the likelihood of attracting unemployed persons to a household.  Some unemployed do not benefit from this safety net, and the presence of unemployed members pulls many households supporting them into poverty.  We also show that the household formation response draw some of the unemployed away from employment opportunities, and thus lowers their employment prospects.