Poverty and health

A cross-sectional ecological study of spatial scale and geographic inequality in access to drinking-water and sanitation
Yu W, Bain RES, Mansour S and Wright JA: International Journal for Equity in Health13(113): November 2014

Measuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation. Spatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. Four variants of the dissimilarity index were used to estimate geographic inequality in access to both services using large and small area units in each country through a cross-sectional, ecological study. Inequality was greatest for piped water in South Africa in 2001 and lowest for access to an improved water source in Uganda in 2008. For sanitation, inequality was greatest for those lacking any facility in Kenya in 2009 and lowest for access to an improved facility in Uganda in 2002. Although dissimilarity index values were greater for smaller area units, when study countries were ranked in terms of inequality, these ranks remained unaffected by the choice of large or small area units. International comparability was limited due to definitional and temporal differences between censuses. This five-country study suggests that patterns of inequality for broad regional units do often reflect inequality in service access at a more local scale. This implies household surveys designed to estimate province-level service coverage can provide valuable insights into geographic inequality at lower levels.

A pro-poor critique of pre-payment water meters in South Africa - The Phiri story
Dugard J: Critical Health Perspectives 2 (2), 2007

Responding to the multiple violations posed by prepaid meters (PPMs) in Phiri, in July 2006 an application was launched in the Johannesburg High Court by five applicants, on behalf of themselves, their households and all residents of Phiri who are in a similar position to the applicants, as well as everyone in the public interest. The application, supported by the Coalition Against Water Privatisation and defended by the Centre for Applied Legal Studies (CALS), seeks to have PPMs declared unlawful and it asks the Court to order Johannesburg Water to provide everyone in Phiri with a FBW supply of 50lcd and the option of a conventional meter at the cost of the City of Johannesburg. The applicants and their supporting organisations believe that the case will be critical to securing the constitutionally- guaranteed rights of poor people to dignity, healthcare and sufficient water.

A Recovery for All: Rethinking Socio-conomic Policies for Children and Poor Households
Ortiz I and Cummins M: United Nations Children's Fund (UNICEF), 29 February 2012

This new book by UNICEF details how the economic crisis continues to inflict devastating social consequences worldwide. In it, the authors note how access to public goods and services is also increasingly being challenged in the worldwide drive toward austerity measure in terms of reduced social spending. While the average gross domestic product of developing countries is contracting at nearly double the rate as their developed counterparts, combined price, income and service delivery shocks in these nations have potentially severe and irreversible consequences, especially for children, the authors argue. Among these include increased hunger and malnutrition, worsening health outcomes, lower school attendance, higher rates of child labour and domestic violence, rising vulnerability to future shocks and widespread social unrest. Even when faced with shrinking budgets, governments can expand their fiscal space without incurring immense cost, the authors argue. This can be achieved by: re-allocating public expenditures; increasing tax revenues; lobbying for increased aid and transfers; tapping into fiscal and foreign exchange reserves; borrowing and restructuring existing debt; and/or adopting a more accommodating macroeconomic framework.

A Story in Words and Images from Cassa Banana Informal Settlement, Zimbabwe
Kaim B: Training and Research Support Centre (TARSC) Cassa Banana Community Health Committee and Community (CBCHC), August 2016

The Training and Research Support Centre and Zimbabwe Association of Doctors for Human Rights reported on how Participatory Action Research (PAR) was used in the Cassa Banana community to explore, analyse and take action on priority health problems faced by the community. PAR activities led to the formation of a Community Health Committee (CHC) and the development of a community action plan that prioritised lack of clean water and poor sanitation as the key health problem in the area. The work in Cassa Banana is building a body of knowledge on strategies to support community efforts to take action and on how to hold duty bearers accountable. As part of this process, in October 2015, nine community members were trained as community photographers using a PAR tool called Photovoice. The photographers took hundreds of photographs reflecting the lives and struggles in their community. They then self-edited the photographs to be included it in a 12-page advocacy booklet that described their community. It showcases challenges in the community and the community’s response to it. Some of the questions included are: Has the process of taking and using the photos deepened understanding of underlying conditions at community level? Has it changed relations and/or levels of organizing between community members (both photographers and non-photographers)? And what impact has use of the booklet had in facilitating changes in interactions with duty bearers? Cassa Banana and partners will be reflecting on these questions in the coming months.

A strategy to increase adoption of locally-produced, ceramic cookstoves in rural Kenyan households
Silk BJ, Sadumah I, Patel MK, Were V, Person B, Harris J et al: BMC Public Health 12(359), 16 May 2012

Exposure to household air pollutants released during cooking has been linked to numerous adverse health outcomes among residents of rural areas in low-income countries. This study describes the roles of local vendors, behaviour change, promotional incentives, and integration of cookstoves with household water treatment interventions to motivate adoption of locally-produced, ceramic cookstoves (upesi jiko) in an impoverished, rural African population. The project was conducted in 60 rural Kenyan villages in 2008 and 2009. During an initial, eight-month assessment period in 10 villages, 159 (75%) of 213 upesi jiko sales occurred in five villages where vendors received behaviour change training. The combined strategy was found to effectively motivate the adoption of cookstoves into a large number of households. The mobilisation and training of local vendors as well as appropriate promotion and pricing incentives created opportunities to reinforce health messages and promote the sale and installation of cookstoves. The authors conclude that additional applications of similar strategies will be needed to determine whether the strategy can be exported equitably and whether reductions in fuel use, household air pollution, and the incidence of respiratory diseases will follow.

A Wolf in Sheep’s Clothing? An analysis of the ‘sustainable intensification’ of agriculture
Friends of the Earth International: October 2012

While the challenges facing agriculture are clearly urgent, this paper questions the thrust of ‘sustainable intensification’. Sustainable intensification is reported by the author to include technology-based approaches through strategies developed without participation of small farmers. The author argues that most of the world’s food is grown by small farmers, without the use of industrial inputs, and using traditional seed varieties. Small farmers have raised their own priorities as a sustainable agriculture that builds on farmers’ own expertise and knowledge, with clear land rights, and rights for women, including agrarian reforms; agricultural research that starts by asking farmers what they need; knowledge and technologies that are based on agro-ecological principles, including compost, integrated pest management and mixed cropping; seed development based on traditional varieties; and mechanisms to protect local farmers from unfair competition from imported products.

Acceptability of conditions in a community-led cash transfer programme for orphaned and vulnerable children in Zimbabwe
Skovdal M, Robertson L, Mushati P, Dumba L, Sherr L, Nyamukapa C, Gregson S: Health Policy and Planning 29(7): 809-817, September 2013

Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash transfers is an issue of controversy. This article sets out to investigate the overall buy-in of conditions by different stakeholders and to identify pathways that contribute to an acceptability of conditions. The article draws on data from a cluster-randomized trial of a community-led cash transfer programme in Manicaland, eastern Zimbabwe. The study found a significant and widespread acceptance of conditions primarily because they were seen as fair and a proxy for good parenting or guardianship. In a socio-economic context where child grants are not considered a citizen entitlement, community members and cash transfer recipients valued the conditions associated with these grants. The community members interpreted the fulfilment of the conditions as a proxy for achievement and merit, enabling them to participate rather than sit back as passive recipients of aid.

Access and quality education to improve lives
Dlamini N: BuaNews, 26 April 2007

Improvements in both the quality of South Africa's education system and students'access to it, would contribute to improving people's lives, says Deputy President Mlambo-Ngcuka. "It is required for the shared, sustainable and accelerated growth that we need to eradicate poverty and improve the livelihoods of our people," the deputy president said Wednesday, unveiling the Bokamoso Barona Investment Trust in Johannesburg. The entire investment trust initiative, speaks of the necessity of the strategic partnership required between the public and private sectors to maximise resources to overcome poverty, unemployment and the social ills that afflict South Africa.

Access to Land is Critical for the Poor
World Bank Group: 8 April 2013

At the Annual World Bank Conference on Land and Poverty convened in early April 2013 in Washington, DC, the World Bank Group issued this statement. In the light of land grabs by multinationals that displace smallholder farmers, the Group argues that modern, efficient and transparent policies on land rights are vital to reducing poverty and promoting growth, agriculture production, better nutrition and sustainable development. It supports and endorses the Voluntary Guidelines on the Responsible Governance of Tenure of Land, Fisheries and Forests in the Context of National Food Security (the VGs). These guidelines are a major international instrument to inform specific policy reforms, and inform Bank procedures and guidance to clients. The World Bank Group is already working with countries to implement the VGs, with a special focus on Africa. With its partners, it has also developed the Land Governance Assessment Framework (LGAF) as a diagnostic tool to assess the status of land governance at the country level. LGAF assessments have been carried out - or are underway - in 18 countries, 10 of them in Africa.

Achieving Food Security in Southern Africa

In 2001–3 in many countries in Southern Africa national grain stocks had been run down and grain imports were slow to arrive, so that localised harvest shortfalls quickly resulted in three- and four-fold increases in food prices which, for the large number of vulnerable people in the region, spelled crisis. In the end, the donor and government response but equally importantly the response of the commercial sector and people’s own ‘coping’ strategies meant that large-scale famine-related deaths were avoided in 2002 and 2003 but unacceptable levels of chronic food insecurity remain.

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