Human Sciences Research Council

Abstract Background Health system responsiveness is regarded as a core goal of health systems, both for its intrinsic value and its potential to contribute to inclusive, participatory, and accountable health systems. Although responsiveness is frequently mentioned in health policy documents, the public experience challenges in engaging with and eliciting responses from health systems. There is also limited receptivity to public concerns by policymakers and health providers. We analysed national policy documents for responsiveness content and framing with the aim of identifying how to strengthen policy proposals towards more responsive health systems. Methods We conducted a three-stage qualitative analysis of Kenyan and South African policy documents: (1) policy document retrieval; (2) data extraction and coding; and (3) content and framing analysis. We analysed purposively selected public sector plans, legislative instruments and health-sector specific plans and policies released between 1994 and 2024 (n = 28 [Kenya]; n = 26 [South Africa]). Documents were identified from government and Ministry of Health websites. Results Responsiveness was framed differently across the analysed texts. Public sector and legislative instruments primarily adopted public participation frames, while health sector documents predominantly framed responsiveness as ‘health service feedback’. Within health sector policy documents, the measurement of responsiveness was underdeveloped, with no clear overarching strategy to support the achievement of system responsiveness. There was also little evidence of intention to integrate feedback from multiple channels and limited description of monitoring and evaluation of feedback mechanisms. There was almost no attention to how public feedback could be used to shape a responsive health system. Conclusion In Kenya and South Africa, while legislative and public policy documents had a broad and inclusive remit for responsiveness, health policy documents had a narrow focus with a dominant ‘health service feedback’ framing. This framing undermines a systemic approach to responsiveness by inadequately addressing equity challenges and power and knowledge differentials between the public and health system actors. Integrating the broader frames identified in public sector and legislative instruments (public participation, accountability) into health policy documents can re-define health system responsiveness to include a focus beyond service delivery, attention to the wider public, including varied population segments and vulnerable groups.

ABSTRACT The concept of creative destruction emphasizes how the turnover of businesses and workers drives innovation, productivity gains and aggregate economic growth, even as individual firms and employees experience disruption. This article leverages administrative tax data for South Africa that measures flows rather than stocks, enabling a dynamic analysis of labour and firm adjustments. Our findings reveal unexpectedly high levels of churn in both jobs and business establishments, suggesting fluid rather than rigid markets. However, job and business creation mirror destruction, resulting in low net growth. Moreover, sectoral shifts over time have not increased the share of tradables, implying that structural transformation has stalled.

Abstract Identity-based discrimination – unfair treatment by systems and individuals based on social status – is a recognised determinant of health and wellbeing, yet evidence centred on young people living in Global South contexts of exclusion, inequality and oppression remain limited. This article draws on a rapid review of 53 studies examining discrimination related to gender, sexual orientation, race/ethnicity, (dis)ability, geography, and religion. Outcomes were assessed using the Gender and Adolescence Global Evidence (GAGE) framework spanning six domains: psychosocial wellbeing, bodily integrity, education, physical health, economic empowerment, and voice and agency. Most studies reported adverse psychosocial outcomes, with fewer documenting effects on bodily integrity, education, or physical health. Very few addressed economic disempowerment or barriers to voice and agency. The review highlights important gaps and identifies five priorities: expanding evidence on economic impacts; examining protective factors and interventions through intersectional approaches; comparative analyses between Global North and South youth; extending geographical, age and setting coverage; and advancing longitudinal and intersectional research that capture the cumulative effect of discrimination on Global South youth.

Abstract In a knowledge-driven global economy, the ability of cities to attract and retain high-level skills is crucial for urban competitiveness. In response, many advanced cities have adopted proactive policies to attract globally mobile talent and support innovation ecosystems. This paper examines whether and how South Africa’s eight metropolitan municipalities incorporate talent attraction and retention into their Integrated Development Plans and related economic strategies. Using a multidisciplinary policy framework and content analysis of municipal documents, we find limited recognition of human capital as a development driver. This omission reflects deeper challenges within existing institutional and governance arrangements, including fragmented mandates, limited planning capacity, and competing developmental priorities. We argue that more deliberate and integrated skills strategies—aligned with inclusive growth objectives—can enhance municipal effectiveness and support resilient urban development.

This manuscript investigates the relationship between adolescents’ aspirations and academic performance, focusing on self-concept dimensions such as self-esteem, self-efficacy, and self-regulation. Using empirical data and a longitudinal design, the study examines how these elements of self-concept mediate the link between aspirations and academic success, with particular attention to adolescents from diverse socio-economic and cultural backgrounds in South Africa. Although the research is situated in a historically racialized educational system, the findings reveal that socio-economic disparities, rather than race alone, are key drivers of educational outcomes. By applying the lens of critical racial consciousness, this study highlights how systemic inequalities in schooling contexts interact with psychological factors to influence learner development. Findings showed that self-regulation, academic self-efficacy, and self-esteem were positively linked to performance. In addition, systemic inequalities such as resource deprivation, underfunding and curriculum marginalisation restricted students’ possibilities. The manuscript offers actionable insights for educators and policymakers by advocating for interventions that support self-concept development in under-resourced environments. It argues that fostering self-efficacy, self-regulation, and self-esteem is essential for enabling students to bridge the aspiration-attainment gap. Through the lens of critical racial consciousness, the manuscript contributes to the discourse on educational psychology and adolescent development by emphasizing the need for targeted interventions that consider the structural and social determinants shaping youth aspirations and achievement.

BackgroundAdolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes.ObjectiveThis pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa.MethodsThe “Teen MomConnect” intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants’ pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups.ResultsOverall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages (“high-responders”; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045).ConclusionsEngagement with the intervention’s 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence.Trial RegistrationPan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565International Registered Report Identifier (IRRID)RR2-10.2196/43654

Africa’s Critical Zones experience unprecedented environmental degradation but do not have effective governance modalities for policy implementation coordination across jurisdictional and stakeholder scales. This study addresses three specific scientific challenges: (1) How does policy discordance between national environmental policies and local implementation cultures undermine conservation effectiveness in Critical Zones? (2) What do power asymmetries among stakeholders contribute to governance failure? (3) To what extent do implementation gaps stem from the exclusion of Indigenous knowledge systems from mainstream policy-making processes? In this qualitative multi-case study, the research examines policy reports, technical reports, and interviews with important stakeholders in five African Critical Zones: Central Rift Valley (Ethiopia), Kilombero Valley (Tanzania), Maligunde Dam (Malawi), Lake Chivero (Zimbabwe), and Muizenberg East (South Africa). Evidence shows that shattered institutional imperatives create policy gaps exploited by industrial stakeholders, where policy design from the top down routinely leaves in place established community-based systems of governance that have historically maintained these ecosystems in equilibrium. Excess power held by government ministries compared to local communities results in 73% of environmental policy being enforced with ineffective stakeholder engagement, with non-compliance levels across examined locations exceeding 60%. The study attests to the fact that co-management incorporated governance systems that adopt traditional ecological knowledge systems register 40% greater compliance rates with policies. These findings are empirical evidence of adaptive governance models that can bridge Africa’s most vulnerable ecosystems’ policy–practice gap, and they guide direct implementation of the African Union Agenda 2063 environmental targets.

This article explores women-led vigilantism in South Africa’s rural Eastern Cape province following the COVID-19 pandemic. Drawing on long-term ethnography, we argue that women vigilantes perceive violent discipline as a necessary response to community leaders’ and police failure to punish crimes that primarily impact single women. We argue firstly that this women-led vigilantism may be seen not only as a manifestation of popular justice, but also as a form of popular gender justice, taking its form in relation to manifestations of patriarchal violence and vulnerability to which it responds. We also connect women-led vigilantism to a rise in illicit hard drug use among young, marginalised men, highlighting how vigilantism relies on and sustains constructions of “the criminal.” Finally, despite belief among these women that their vigilantism is winning them security and respect, we question whether their actions effectively address the patriarchal power relations that shape women’s vulnerability given their focus on punishing young, drug-dependent men who have little social power.