The weak quality of education received by most poor children in South Africa places them in permanent disadvantage relative to those attending the mainly more affluent and better performing schools. This document draws from a large number of studies undertaken for a major project and summarises this evidence, which illustrating that low quality schools act as a poverty trap.

BackgroundThis study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population.MethodsThe study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors.ResultsThree hundred and forty persons consulted someone about their cough and this represents 37% of the 922 participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic origin (OR 1.99, 95% CI 1.28–3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95% CI 1.00–1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01–1.04, P < 0.01) had a higher likelihood of consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45–0.88, P < 0.01) and those with higher levels of socio-economic status (OR 0.81, 95% CI 0.71–0.92, P < 0.01) were less likely to consult. We find no evidence of stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and reliably capturing stigma due to, amongst other factors, social desirability bias.ConclusionsThe low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not seek care.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3992-6) contains supplementary material, which is available to authorized users.

The primary goals of water pricing are to ensure that water is used sparingly and that sufficient revenues are earned. Pricing can, however, also be used to address equity concerns. One such policy often applied in developing countries is to charge a higher marginal price as consumption increases, to encourage a more efficient use of water, and to finance water subsidies by crosssubsidising water use. However, in reality water subsidies do not necessarily reach their intended beneficiaries. This paper explores the efficacy of such a pricing structure in subsidising water consumption for poor households in South Africa. The main finding is that this pricing structure does not ensure that water subsidies reach the intended targets; that is, the poorest. A further important result from these findings is that the magnitude of redistribution via the water tariff system is relatively small compared with other components of social spending.

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