Dissertation on Health System (pdf)

Running head: DISSERTATION
Dissertation
Name of the Student
Name of the University
Author note

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Table of Contents
Chapter 1:.........................................................................................................................................4
1.1 Introduction................................................................................................................................4
1.2 Background................................................................................................................................6
1.3 Research Gap and rationale.......................................................................................................8
1.4 Research question......................................................................................................................9
1.5 Aims.........................................................................................................................................10
1.6 Objectives................................................................................................................................10
1.7 Summary..................................................................................................................................10
Chapter 2: Literature review..........................................................................................................11
2.1 Introduction..............................................................................................................................11
2.2 HIV/AIDS/AIDS Prevalence...................................................................................................12
South Africa...............................................................................................................................12
Zimbabwe..................................................................................................................................14
2.3 HIV/AIDS pandemic drivers...................................................................................................17
South Africa...............................................................................................................................17
Zimbabwe..................................................................................................................................19
2.4 Health systems and HIV/AIDS pandemic...............................................................................22
South Africa...............................................................................................................................22
Zimbabwe..................................................................................................................................24

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Right to Health...........................................................................................................................25
Policies in South Africa and Zimbabwe....................................................................................28
Existing programs in South Africa and Zimbabwe...................................................................31
South Africa...............................................................................................................................31
Zimbabwe..................................................................................................................................33
Political and Economic influences.............................................................................................36
Chapter 3: Methodology................................................................................................................39
3.1 Introduction..............................................................................................................................39
3.2 Method outline.........................................................................................................................40
3.3 Research onion.........................................................................................................................41
3.4 Research philosophy................................................................................................................42
3.5 Research approach...................................................................................................................42
3.6 Research strategy.....................................................................................................................43
3.7 Time horizon............................................................................................................................44
3.8 Data collection and analysis....................................................................................................44
3.9 Research design.......................................................................................................................45
3.9.1 Keywords..............................................................................................................................47
3.9.2 Bibliographic aids.................................................................................................................47
3.9.3 Inclusion and exclusion criteria (search strategy)................................................................48
3.9.4 Secondary Research..............................................................................................................50

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4. Search strategy...........................................................................................................................50
5. Search outcomes........................................................................................................................50
6. Ethical considerations................................................................................................................51
7. Limitations of the study.............................................................................................................52
8. Chapter summary.......................................................................................................................53
Chapter 4: Results and Discussion................................................................................................53
Discussion......................................................................................................................................53
Gender inequality and vulnerability of children........................................................................53
Human rights abuses and HIV...................................................................................................55
Economic challenges (grants/funds/).........................................................................................58
Ineffective implementation HIV and AIDS policies.................................................................60
Imperfect Anti-retroviral treatment...........................................................................................62
Lack of effective prevention program.......................................................................................66
Chapter 5: Recommendations and Conclusion..............................................................................68
Behavioural interventions..........................................................................................................69
Biomedical interventions...........................................................................................................70
Structural interventions..............................................................................................................72
Conclusion.................................................................................................................................74
References......................................................................................................................................76

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Chapter 1:
1.1 Introduction
From last two decades, HIV/AIDS/AIDS/AIDS has crippling effects on many countries’
healthcare systems like sub-Saharan Africa and Zimbabwe. There are high rates of new infection
and HIV/AIDS/AIDS remains stigmatized among the population with little access to healthcare
services in the treatment, and prevention of HIV/AIDS/AIDS (Sharp and Hahn 2011). There is
limited support and understanding of HIV/AIDS/AIDS prevalence data and health needs of the
population across these regions. The pandemic of HIV/AIDS/AIDS has compromised the ability
of the countries’ healthcare systems in delivering quality care especially in terms of increase in
morbidity. HIV/AIDS/AIDS has changed the phase of care delivery offered by hospitals and
clinics with constraints in health budgets that has resulted in shifted resources towards
HIV/AIDS/AIDS and vertical care delivery for the people infected with HIV/AIDS/AIDS+. In
Africa, there is lack of healthcare services that has a negative effect on worldwide epidemics
especially HIV/AIDS/AIDS (Callaghan, Ford and Schneider 2010).
Apart from healthcare systems, other factors like social, political and economic factors
contribute to the fact that it is considered a serious public health issue prevailing in the continent.
On an international level, HIV/AIDS/AIDS pandemic is recognized as an issue of human rights.
Regional and national responses to HIV/AIDS/AIDS in South Africa recognized the need for
integration of human rights-based approaches for the management of HIV/AIDS/AIDS
effectively with increase in universal access to healthcare services (Mayosi and Benatar 2014). A
relationship exists between human rights and HIV/AIDS/AIDS prevalence highlighted in three
sections. There is increased vulnerability where certain groups become more vulnerable to

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HIV/AIDS/AIDS virus contraction, as they are unable to recognize their political, civil,
economic, cultural and social rights. The rights of the people living with HIV/AIDS/AIDS are
violated due to presumed notion on HIV/AIDS/AIDS status that makes them suffer the burden of
the disease and rights violation. Stigma and discrimination often obstruct the access to healthcare
services that affect housing, education and employment (Mill et al. 2010). This in turn
contributes to the vulnerability to spread of infection as it discourages the affected individuals to
seek treatment and social services. In the third section, strategies developed to address
HIV/AIDS/AIDS pandemic are hampered as human rights are violated. Stigmatization of
vulnerable groups hinders them to reach out to the treatment and prevention efforts and as a
result, it increases HIV/AIDS/AIDS vulnerability.
The prevalence and impact of HIV/AIDS/AIDS is inextricably linked with human rights.
There is a lack of respect for human rights that instigate the spread and exacerbation of impact of
HIV/AIDS/AIDS that in turn undermines the progress in human rights realization especially in
these two countries. The influence and magnitude on politics, economics and society
distinguishes HIV/AIDS/AIDS pandemic in Africa and Zimbabwe. Communities and individuals
in South Africa and Zimbabwe need to realize their rights to health and non-discrimination
where individual and societal HIV/AIDS/AIDS impact needs to be reduced (Gruskin et al. 2013).
The individuals affected with HIV/AIDS/AIDS need to be protected from stigmatization and
treated with respect and dignity, access to HIV/AIDS/AIDS treatment and care. The promotion
and protection of human rights are essential in the prevention of HIV/AIDS/AIDS transmission
and mitigation of economic and social impact of HIV/AIDS/AIDS pandemic in these countries.
Moreover, communities should have greater ability to respond to HIV/AIDS/AIDS pandemic
and international response is required in respect to HIV/AIDS/AIDS grounded in cultural, civil,

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political, social and economic rights (Viljoen 2012). Therefore, the focus of the dissertation is to
explore the impact of health systems in South Africa and Zimbabwe and to analyse the national
health policies, programs and schemes in order to provide essential healthcare to the people in
these two countries despite of their socio-economic status.
1.2 Background
World Health Organization has recognized the notion that all human beings have equal
rights to lead a quality life and receive better care irrespective of gender, ethnicity, age and social
background (Zahn et al. 2016). This suggests that health is of paramount importance and basic
concern considering it as a human right. Every human being has the right to attain highest
standard of health being a fundamental right. The right to health is fundamental to mental and
physical well-being for every individual and for exercising human rights in the sections of the
South African Constitution (Woods, 2014). The services comprises of universal access to basic
healthcare services as mentioned in the section 27(1) (a) of the Constitution. International
Covenant on Economic, Social and Cultural Rights (ICESCR) is a treaty adopted by Universal
Declaration of Human Rights that focuses on cultural, social and economic features must for
every citizens in the country (Saul, Kinley and Mowbray 2014). The Article 12 of the ICESCR
outlines that every individual have the right to enjoy the highest attainment of mental and
physical health to live a life of dignity. Every citizen has the right to health and no State should
refrain from limiting or denying them the access to healthcare services. However, the real
scenario is different as in the developing countries like Africa; there is lack of quality healthcare
in terms of corrupt government and policies with lack of resources that has greatly influenced the

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prevention and treatment of infectious diseases like HIV/AIDS/AIDS affecting the population
(Saul, Kinley and Mowbray 2014).
In South and East Africa, the rate of new HIV/AIDS/AIDS infections has reduced
dramatically by 30% and halved among the children population since 2001 and number of adults
newly infected with HIV/AIDS/AIDS was low during the year 2011 (Rehle et al. 2010). Despite
of this progress, South Africa continues to withstand the worst of the HIV/AIDS/AIDS where
about 1 in 20 adults accounting for 4.9% and 69% people living with the disease (Mayosi et al.
2012). In Zimbabwe, adult HIV/AIDS/AIDS prevalence accounts for 13.7% being declared as
one of the five top countries hardest hit by HIV/AIDS/AIDS globally (Mayosi et al. 2012). This
country also faces multifaceted economic and political crisis that has manifested through high
food insecurity and collapse of Health and Education systems that resulted in lack of
HIV/AIDS/AIDS interventions as reported by UNICEF. In the same year, National Health
Insurance (NHI) and in 2015, South African government for accessibility of cheap antiretroviral
therapy (ART) implemented ratification of the ICESCR (Nkuepo 2011). On a contrary, despite
of ICESCR implemented in 2011 by Zimbabwean government, the healthcare system is unable
to fulfil the increasing demands of basic medical resources for treatment along with rights
violation in the country by the ruling government and disputed discourse for a long time
(Zw.one.un.org 2018). This situation has put lot of pressure on the government in the prevention
and treatment of HIV/AIDS/AIDS pandemic in the country.
Considering the above situation, the dissertation will explore the impact of health systems
and analyse the literature associated with right of health as notion in South Africa and Zimbabwe
in context to health and well-being of their people in these countries. Furthermore, the
dissertation intend to consider literature on impact of national healthcare policies and updated