Browsing by Author "Von Fintel, Dieter"

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    Examining the impact of WHO’s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi : a retrospective study
    (BMC (part of Springer Nature), 2019-05-08) Mchenga, Martina; Burger, Ronelle; Von Fintel, Dieter
    Background: A variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO). One such model is the 2001 Focused Antenatal Care (FANC) programme. FANC recommended a minimum of four visits for women with uncomplicated pregnancies and emphasised quality of care to improve both maternal and neonatal outcomes. Malawi adopted FANC in 2003, however, up to now no study has been done to analyse the model’s performance with regards to antenatal care service quality and utilisation patterns. Methods: The paper is based on data pooled from three comparable nationally representative Malawi Demographic and Health Survey (MDHS) datasets (2000, 2004 and 2010). The DHS collects data on demographics, socio-economic indicators, antenatal care, and the fertility history of reproductive women aged between 15 and 49. We pooled a sample of 8545 women who had a live birth in the last 5 years prior to each survey. We measure the impact of FANC on early access to care, underutilisation of care and quality of care with interrupted time series analysis. This method enables us to track changes in both levels and the trends of our outcome variables. Results: We find that FANC is associated with earlier access to care. However, it has also been associated with unintended increases in underutilisation. We see no change in the quality of ANC services. Conclusion: In light of the WHO 2016 ANC guidelines, which recommend an increase of visits to eight, these results are important. Given that we find underutilisation when the benchmark is set at four visits, eight visits are unlikely to be feasible in low-resource settings.
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    Intergenerational transfer of health inequalities : exploration of mechanisms in the Birth to Twenty cohort in South Africa
    (BMJ, 2019) Von Fintel, Dieter; Richter, Linda
    South Africa’s history of colonialism and Apartheid contributed to its extreme levels of inequality. Twenty-five years after the transition to democracy, socio-economic and health inequalities continue to rank among the highest in the world. The Birth to Twenty+ study follows a cohort born in urban Johannesburg in 1990 through their early lives and into young adulthood. Also known as ‘Mandela’s Children’, these ‘children of the ‘90s’ were the first generation to be raised in a democratic society, whose elected government implemented policies to achieve greater socio-economic and health equality. Correlating early life outcomes to those of their parents provides a baseline estimate of intergenerational transmission of historical inequality. Analyses of their early life course indicates the potential breakdown in inequality in the first generation. This paper provides an overview of empirical results on intergenerational change in socio-economic status and health during South Africa’s political transition. Access to infrastructural services improved, and poverty reduced following the rapid expansion of unconditional cash transfers mainly to children and pensioners. However, unemployment remained high and job discrimination continued. Inequalities in health follow similar patterns, and progress did not equate to convergence. Some catch-up physical growth occurred—both across groups and over time—but not sufficient to bridge cognitive inequalities. Socio-economic and health inequalities continued as the children of the ‘90s reached young adulthood. Based on knowledge of other transitions, it is likely that these inequalities will only start to break down in later generations, provided social and economic progress holds steady.
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    Rising unemployment in South Africa : an intertemporal analysis using a Birth Cohort Panel
    (Stellenbosch : University of Stellenbosch, 2007-03) Von Fintel, Dieter; Burger, R.; Van der Berg, Servaas; University of Stellenbosch. Faculty of Economic and Management Sciences. Dept. of Economics.
    A new political dispensation in 1994 heralded a period of optimism for many ordinary South Africans, who hoped for freedom and an escape from poverty. Since this transition, however, South Africa has registered steady increases in unemployment, which was already high and widespread at that stage. The new policy environment introduced a mix of legislation which changed the way in which South African society was to be structured: separate development was abandoned, the pillars of Apartheid dismantled, and equitable access to education and jobs was enacted. At the same time, the Reconstruction and Development Programme (RDP), as well as the Growth Employment and Redistribution (GEAR) document addressed, amongst other issues, socioeconomic and labour market disparities. Economic growth was to bolster employment generation. Rising unemployment is, in light of these diverse changes, a source of considerable concern to labour market participants and policymakers alike: the benefits of better understanding the dynamic forces at play are potentially large. Given the many and farreaching changes referred to above, it is a complex task to disentangle specific reasons for the outcomes realised in the labour market, and more so the manner in which these have interacted to arrive at the status quo...
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    Spatial heterogeneity, generational change and childhood socioeconomic status : microeconometric solutions to South African labour market questions
    (Stellenbosch : Stellenbosch University, 2014-12) Von Fintel, Dieter; Burger, Rulof; Van der Berg, Servaas; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
    ENGLISH ABSTRACT: Microeconometric techniques have improved understanding of South Africa’s labour market substantially in the last two decades. This dissertation adds to this evidence by considering three separate labour market questions, with particular attention to data quality and the application of credible methodology. Firstly, wage flexibility is investigated. Whereas selected previous microeconometric evidence suggests that wage setters in South Africa are highly responsive to external local labour market circumstances, it is not corroborated by macroeconomic and other microeconometric studies. This question is interrogated again, with particular attention to methodological issues in wage curve estimation. The latter is a robust negative relationship between individual wages and local unemployment rates, found in most countries, except where bargaining is highly centralized. Adding time variation to the data allows controls for spatial heterogeneity to be introduced, leading to the conclusion that wages are really inflexible in the short-run. Rather, the trade-off between wages and local unemployment that previous work has found represents a long-run spatial equilibrium. This finding is robust to instrumentation for reverse causality and the measurement error that is associated with choosing incorrect labour market demarcations. Secondly, the reliability of retrospective data related to childhood is investigated, with the view of estimating the long-run influence that early life circumstances have on adult outcomes. Two indicators, parental education and subjective rankings of childhood socioeconomic status, are evaluated. The first set of indicators has poor response rates, as many South African children live without their parents. Where respondents do volunteer this information, they answer consistently across waves. Subjective rankings have higher response rates, as they require respondents to provide information about their own past, and not about those of their parents. However, individuals’ assessments are inconsistent over time, despite being asked about the same point in the life cycle. They tend to change their view of the past in line with adjustments to perceptions of their position in the village income distribution and subjective well-being, providing clear evidence of anchoring. Instrumental variables analysis has been used in previous studies to account for measurement error in subjective data. However, if anchoring affects all assessments of the past and potential outcome variables (such as employment), microeconometric techniques will yield biased estimates of the effects of childhood on long-run outcomes. Finally, age-period-cohort models for South African labour force participation are estimated. This chapter is the first contribution to relax the assumption that cohort differences must remain permanent over the life cycle. Monte-Carlo simulation studies show that highly interactive specifications can partially recover the true underlying process. Using a variety of techniques (imposing behavioural restrictions and atheoretical approaches), this study shows that cohort effects in labour force participation can be temporary in South Africa, though more data is required to verify this conclusively. Regardless of technique, a distinct surge in labour force participation is noted for the group born after 1975. Pertinently, the combination of testable assumptions and highly flexible estimation can yield credible age-period-cohort profiles, despite the many disputes noted in the literature. Previous evidence of a surge in participation for the post-1975 cohort can now be shown to be temporary rather than a part of a long-run generational increase.
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    An unequal harvest: The French Huguenots and early Cape wine-making ['n ongelyke oes: Die Franse Hugenote en die vroeë Kaapse wynbedryf]
    (SCOPUS, 2011-09) Fourie, Johan; Von Fintel, Dieter
    There is as yet little understanding of the impact of the arrival of French Huguenots during 1688/1689 on the Cape wine industry in the Dutch Cape Colony. Van Riebeeck already produced the first wine at the Cape in 1659. Under Company officials, notably Simon and Willem Adriaan van der Stel, production expanded rapidly until, at the turn of the 17th century, the Lords XVII in Amsterdam limited private farm ownership by Company officials and paved the way for free farmers to take up viticulture. These included the 159 French Huguenots that had arrived a decade earlier to augment the free European population at the Cape by at least a third. Not all farmers were instantly successful, however, and, after rapid early adoption, wine production increased piecemeal over the course of the eighteenth century. Most of this activity was restricted to the areas west of the first mountain ranges. We posit that the skills, knowledge and secrets of wine-making the French Huguenots possessed at their arrival allowed them to produce better quality wines more productively than the non-French settlers. By using quantitative production data - the opgaafrolle were collected for the purposes of taxation - over more than seven decades of European settlement, we show that the Huguenots produced significantly more wine and did so more productively than the other settlers. The dataset allows for a number of control variables, including inputs (vines and wheat reaped, which also acts as a proxy for land), other capital (slaves, horses and cattle) and labour (knechts, or European labourers). But the standard factors of production (land, capital and labour) do not explain the difference: the "additional advantage" of the Huguenots remain despite these controls. The only plausible alternative hypothesis is that the knowledge, skills and secrets of viticulture allowed these Huguenots to produce quality wine, an invaluable asset in the fight against scurvy on the long ship voyages between Europe and the East. We test this hypothesis by splitting the sample into two groups: those that originate from wine-producing provinces in France and those that originate from non-wine producing provinces. Using only this subsample (and thus eliminating the possibility of institutional differences between the French Huguenots and the other settlers), we show that the Huguenots from wine-producing regions are more adept at making quality wine than their Huguenot compatriots who originate from non-wine producing regions. The skills, knowledge or "secrets" of producing quality wine brought with them from France gave these Huguenots a competitive advantage, which allowed them to consistently secure a market for their produce and thus expand production.
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    Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria
    (BioMed Central, 2020) Ezekannagha, Oluchi; Drimie, Scott; Von Fintel, Dieter; Maziya-Dixon, Busie; Mbhenyane, Xikombiso
    Background: National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states. Methods: A validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it. Results: Of the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively). Conclusions: The final roadmap comprises of actions that are appropriate for the state’s context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.