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The ideas, practicalities, and challenges of establishing effective social protection in Africa are steadily, if somewhat slowly, gaining notice in both policy-making forums and mainstream social policy analysis. The world's second largest and populous continent, Africa is also its poorest region, with chronic poverty, vulnerabilities, and preventable hardship. Despite some significant developments in social welfare interventions and outcomes since the turn of the century, the policy agenda and dynamics in most countries remain complex and tenuous, arguably more so than other lower and middle income (LMIC) regions. This special edition contributes to a critical analysis of the challenges and opportunities facing social protection systems in Africa. It also seeks to examine the extent to which the staple explanatory concepts of welfare dynamics in the northern and western hemispheres – the role of actors, ideas, and institutions – need to be modified or adapted when analysing welfare dynamics in Africa. The focus is on Sub-Saharan Africa (SSA) rather than the more diverse and heterogeneous Middle East and North Africa (MENA) region. While, it is important to acknowledge that SSA nations are also distinct and varied; nevertheless, they share important characteristics in terms of historical contexts, average incomes, development outcomes, and most relevant for the purpose of this analysis, social policy strategies, and challenges. [ABSTRACT FROM AUTHOR]

A new group of Western development donors has emerged as increasingly influential actors in global social policy. Big philanthropies have begun implementing social protection projects on a vast scale across the Global South and have become integrated within global governance structures. It is essential to examine whether their approach to social policy in the South is effective, legitimate and desirable for the substantive agendas and programmes in these countries and for analysis of social policy in a development context. This study investigates contemporary big philanthropies through a qualitative case-study of the Bill and Melinda Gates Foundation and its role in the health sector in Tanzania. It examines the ways in which big philanthropies engage and seek to influence policy on the ground, directly exploring the views and experiences of local stakeholders. The study finds that big philanthropies have distinctive features and mechanisms as global social policy entrepreneurs. In contrast to the vertical and linear processes associated with traditional policy transfer, a more messy and complex set of mechanisms are observed. The study also indicates that despite considerable resources and authority, philanthropic donors may not be effective in securing policy reform within aid-receiving countries due to a lack of transparency and embeddedness. [ABSTRACT FROM AUTHOR]

Despite the absence of an unemployment grant in South Africa, there is growing concern that other social assistance provision might nevertheless weaken work motivation and create a 'dependency culture'. This study explores attitudes about the relationship between grant receipt and paid employment in South Africa. Using both quantitative and qualitative data, it examines whether there is evidence of a 'dependency culture', the nature and strength of labour market attachment among grant recipients, and the opportunities and barriers to employment they face. We found that both those in and out of work placed a high value on paid employment. Joblessness had not become 'normalised', and all categories of the workless were extremely motivated to get work. Grant recipients did not subscribe to a distinctive culture but to mainstream values and aspirations. While some benefit claimants subscribed to popularly promoted prejudices about other social assistance claimants, our findings appear to counter recent concerns about potential unintended effects of the current grant system. The key factors in reducing people's chances of finding employment seem linked to the structural conditions of the labour market and the wider economy rather than the motivational characteristics of the unemployed and the arrangements of the grant system. doi: 10.1017/S0047279409990638

Regulations of junior doctors' work hours were first enacted in the United States (US) and United Kingdom (UK) over a decade ago, with the goals of improving patient care and doctors' well-being while maintaining a high quality of medical training. This study examines experiences and attitudes regarding the implementation of these regulations among physicians and surgeons at two teaching hospitals, one in South-East England, and the other in New England, US. This paper presents the findings of a survey questionnaire and a series of in-depth interviews administered to a sample of junior doctors and the consultants responsible for their supervision. The study finds that the different policy mechanisms employed in the two countries have had different degrees of success in reducing the work hours of junior doctors. The results also indicate, however, that even in settings in which hours have been reduced significantly, the regulations have only had limited effects on the quality of medical care, junior doctors' well-being, and the quality of medical education. A number of barriers to the success of the regulations in achieving their objectives are identified, and the relative merits of political action and professional self-regulation are discussed. This research suggests that recently enacted policies requiring further reductions in junior doctors' hours in both the US and UK may face similar barriers when implemented. Understanding the lessons that emerge from implementation of the original regulations is essential if future reforms are to succeed and a high-quality system of health care is to be sustained. Keywords: Junior doctor; Work hours; Legislation; Professional regulation; Medical education; UK; USA

This article presents key results from a comparative qualitative Social Policy study of nine African regional economic communities' (RECs) regional health policies. The article asks to what extent has health been incorporated into RECs' public policy functions and actions, and what similarities and differences are evident among the RECs. Utilising a World Health Organization (WHO) framework for conceptualising health systems, the research evidence routes the article's arguments towards the following principal conclusions. First, the health sector is a key component of the public policy functions of most of the RECs. In these RECs, innovations in health sector organisation are notable; there is considerable regulatory, organisational, resourcing and programmatic diversity among the RECs alongside under-resourcing and fragmentation within each of them. Second, there are indications of important tangible benefits of regional cooperation and coordination in health, and growing interest by international donors in regional mechanisms through which to disburse health and -related Official Development Assistance (ODA). Third, content analysis of RECs' regional health strategies suggests fairly minimal strategic ambitions as well as significant limitations of current approaches to advancing effective and progressive health reform. The lack of emphasis on universal health care and reliance on piecemeal donor funding are out of step with approaches and recommendations increasingly emphasising health systems development, sector-wide approaches (SWAPs) and primary health care as the bedrock of health services expansion. Overall, the health component of RECs' development priorities is consistent with an instrumentalist social policy approach. The development of a more comprehensive sustainable world-regional health policy is unlikely to come from the African Continental Free-Trade Area, which lacks requisite social and health clauses to underpin 'positive' forms of regional integration. [ABSTRACT FROM AUTHOR]

Abstract Background Child cash transfers are increasingly recognised for their potential to reduce poverty and improve health outcomes. South Africa‘s child support grant (CSG) constitutes the largest cash transfer in the continent. No studies have been conducted to look at factors associated with successful receipt of the CSG. This paper reports findings on factors associated with CSG receipt in three settings in South Africa (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal). Methods This study used longitudinal data from a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding by peer-counsellors in South Africa (ClinicalTrials.gov: NCT00397150). 1148 mother-infant pairs were enrolled in the study and data on the CSG were collected at infant age 6, 12, 24 weeks and 18–24 months. A stratified cox proportional hazards regression model was fitted to the data to investigate factors associated with CSG receipt. Results Uptake of the CSG amongst eligible children at a median age of 22 months was 62% in Paarl, 64% in Rietvlei and 60% in Umlazi. Possessing a birth certificate was found to be the strongest predictor of CSG receipt (HR 3.1, 95% CI: 2.4 -4.1). Other factors also found to be independently associated with CSG receipt were an HIV-positive mother (HR 1.2, 95% CI: 1.0-1.4) and a household income below R1100 (HR1.7, 95% CI: 1.1 -2.6). Conclusion Receipt of the CSG was sub optimal amongst eligible children showing administrative requirements such as possessing a birth certificate to be a serious barrier to access. In the spirit of promoting and protecting children’s rights, more efforts are needed to improve and ease access to this cash transfer program.

Compares outpatient referral patterns in fundholding and non-fundholding practices in the Oxford region before and after the National Health Service (NHS) reforms in April 1991. Increase in referral rates in fundholding practices; Fundholder's use of specialist consultations; Little impact of NHS reforms on out of district referrals.

We report the results of a survey of patients' awareness, attitudes and satisfaction regarding fundholding and related developments in primary care, and compare the responses of patients in fundholding and non-fundholding practices. (Six total fundholding general practices and two non-fundholding general practices in West Berkshire were included.) An anonymous postal questionnaire was sent to 1150 patients with joint pain aged 17–80, of whom 715 (63%) returned completed questionnaires. Few (17%) fundholding respondents had received information from their practice about fundholding or (36%) were aware of new or different services being offered but the majority had heard of fundholding and were able to describe it accurately. Satisfaction with GP services was high in both types of practice, but fundholding patients reported higher levels of satisfaction with getting a referral to a hospital specialist (FH: 81% vs. NFH: 63%), and with the length of time between referral and treatment (FH: 81% vs. NFH: 59%). A majority of patients in both types of practice wanted to be involved in decisions about the services available to them but only a third of patients thought that fundholding would make this easier. Fundholding patients were more likely to report being given enough choice about treatments available to them (51%) than their non-fundholding counterparts (35%). Fundholding patients had not perceived a reduction in quality of care as a result of budgetary pressures and were more satisfied with the process of referral to secondary care than their counterparts in non-fundholding practices. Patients in both types of practice felt that it was important to be involved in decisions about the services available to them, but few thought that this would be more likely as a result of fundholding. Provision of information to patients is a prerequisite for their involvement, but judging by the number of patients receiving any information about fundholding from their... [ABSTRACT FROM AUTHOR]