MODIFICACIONES AL RÉGIMEN SANCIONATORIO TRIBUTARIO

The quantitative section of this thesis analyses a dataset that comes from the Agincourt Health and Demographic Surveillance System (AHDSS), longitudinal data collected by the Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (MRC/Wits Unit)5. The MRC/Wits Unit study site is one of the sites for the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH). The vision of the INDEPTH Network is to ―be an international platform of sentinel demographic sites that provides health and demographic data and research to enable developing countries to set health priorities and policies based on longitudinal evidence‖ (INDEPTH Network, 2007). With this vision and the mandate ―to better understand the dynamics of health transition in rural South Africa in order to mount a more effective public health response‖ (Tollman, 2006), the MRC/Wits Unit set up a

demographic and health surveillance system in the 21 villages of the Agincourt sub- district in the Mpumalanga Province6 of South Africa.

The Agincourt sub-district is situated in what was the Mhala District of Gazankulu, a former ―homeland‖ which belonged to the Shangaan-speaking Tsonga ethnic group (Kahn, 2006). This sub-district, like other areas in former ―homelands‖ in South Africa under apartheid, had no reliable source of vital statistics and continues to be characterized by social and health inequalities entrenched during the apartheid era. As a result of the need to redress the inequalities and lack of vital statistics, the MRC/Wits-Agincourt Unit has been collecting the AHDSS data through an annual census at the study site since 1992. The unit also collects the verbal autopsy data which yield information on the cause of each death at the site.

The study site, with a population that grew from 58,000 in 1992 to about 70,000 in 2006, is now situated in the Bushbuckridge district in South Africa‘s rural north-east, which is adjacent to the country‘s border with Mozambique (see maps in appendix A) (Collinson et al., 2003; Tollman, 2006). As a result, the study population is made up of about one- third Mozambican former refugees, many of whom fled their country during the mid- and late 19th century from war in the Gaza province and later, in the mid-1980s from the RENAMO-FRELIMO conflict (Kahn, 2006). These Mozambicans have now settled in the study area as immigrants. Even though the Mozambicans have strong language, cultural and kinship ties with the South African residents of Gazankulu and are now

legally eligible to have a South African ID and receive social pensions, they still remain a vulnerable group (Schatz and Ogunmefun, 2005; Kahn, 2006)

The geo-ecological zone of the study area is semi-arid with a population density of 148 persons per square kilometre (Collinson et al., 2002; Collinson et al., 2003). Although there have been substantial development initiatives recently, such as electrification and completion of the Inyaka dam, infrastructure is still limited (Kahn, 2006). There is water shortage in most villages as piped water flows erratically and mainly from communal standpipes, where it is collected manually by women or children, usually in 25-litre plastic drums and transported either by wheelbarrow or carried on the head (Collinson et al., 2002). Electricity is also a challenge for most villagers as it is too expensive for all but a minority of inhabitants (Kahn, 2006). Instead, most residents collect and use firewood as their primary fuel source. Most of the roads are not tarred, therefore, they are susceptible to floods and pot holes during rainy season in summer. These floods and pot holes make transportation more difficult between villages, especially since transport is mostly ―public‖, provided by privately owned combis or mini-bus taxis. Housing types range from traditional mud huts with thatched roofs to brick dwellings with tiled or tin roofs; levels of household sanitation are generally poor as pit toilets of varying effectiveness are the norm (Collinson et al., 2002; Kahn, 2006).

The Agincourt sub-district has an extremely modest economy (Kahn, 2006). Since the area is semi-arid, it is more suitable for game farming and low-density cattle farming than crop cultivation (Collinson et al., 2002). However, many villagers grow crops on small

household plots to supplement food bought from local shops and malls in nearby towns (Kahn, 2006). Unemployment is estimated at 40-50%, while many men and women migrate temporarily to work on nearby farms and timber plantations, game reserves and mines, and manufacturing and service industries in urban areas (Kahn, 2006). Most villagers usually engage in food and fruit vending (Collinson et al., 2002).

School enrolment occurs late in the Agincourt sub-district. Although 85% of children between 10 and 14 years enrol at primary school, less than 50% proceed to secondary school and only 3% continue studying after their secondary education (Collinson et al., 2003). Each village has at least one primary school only fourteen of the twenty-one villages have a secondary school (Collinson et al., 2002).

The study site has a health centre and five satellite clinics, all staffed by nurses; three district hospitals are situated 25-60 km from the site (Kahn, 2006). The health care has an ambulance and a small laboratory that performs a limited number of diagnostic tests, while a restricted number of drugs are dispensed from the primary health facilities in the clinics (Collinson et al., 2002). All services are free and these include family planning, ante-natal care, child health, delivery and postpartum care (Collinson et al., 2002). These services, however, are under-utilised due to poor drug supply; villagers also access traditional and faith healers to supplement or replace the care of allopathic practitioners (Collinson et al., 2002; The SASPI Team, 2004b; Kahn, 2006). The under-utilisation of public health facilities may contribute to the prevalent health problems revealed by the AHDSS verbal autopsy analysis such as diarrhoea, kwashiorkor, AIDS, tuberculosis,

cardiac, cerebrovascular, liver and malignant diseases (Kahn et al., 1999; Kahn, 2000; Collinson et al., 2002). In order to understand how this and how other information are collected, the following section focuses on the AHDSS.