Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children. A descriptive qualitative evaluation was conducted in 2020 across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. There were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the programme. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of and how to take the anti-retroviral treatment. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, health care workers felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. This study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased anti-retroviral treatment literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation.
Governance and participation in health
The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination. Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research. GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that GHI earmarking and conditions drive funding allocations regardless of countries’ priorities. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers with both positive and negative implications. To maximise returns on GHI support, the authors suggest that there is need to ensure that their approaches are comprehensive as opposed to being selective; to improve GHI country level governance and alignment with countries’ changing epidemiologic profiles; and to strengthen their involvement of civil society.
How can women in vulnerable circumstances move beyond hopelessness, extreme poverty, and the health and livelihood challenges of a global pandemic? What are the best research approaches to make their experiences count in post-pandemic recovery efforts and future preparedness? Ask them. Two research projects in the provinces of Eastern Cape and KwaZulu-Natal, South Africa, are using experiential methodologies to reveal women’s stories, ideas and solutions to their post-pandemic recovery. By taking two different approaches — one ethnographic and the other a workshop series combined with trial cash transfers —, these two projects aimed to understand the multidimensionality of the lives and circumstances of economically disadvantaged women and investigated different ways to amplify their voices using inclusive approaches. Common themes have emerged from the oral histories collected to date. Researchers report that the pandemic disproportionately affected women, many of whom lost their jobs. Workplaces, health centres and other services closed, leaving women disconnected from their social networks. Adult children and spouses moved home, causing even greater strain and leading to increases in domestic violence. Greater numbers of youth pregnancies added to women’s already difficult care burden. Many women reported that debt closed in. High inflation further compounded the problem, leaving women’s households in a continuous cycle of economic deficit. They continue to struggle with food insecurity and an almost universal dependence on social grants for survival. Women reported a new normal: living with stress, mental illness, isolation and substance use.
This study explored the reproductive health and rights’ needs and challenges amongst young refugee women in South Africa. It was carried out in eThekwini in South Africa in 2021 and 2022 through 35 semi-structured, in person interviews with young refugee women 18 and 24 years old living in the city centre. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women.
This study assessed people’s knowledge of the COVID-19 vaccine and the effect of misinformation on vaccine uptake among healthcare workers (HCWs) and the general population in Uganda. This was a cross-sectional quantitative study conducted in 2022, including 311 HCWs and 253 from the general population. The study revealed that the proportion of vaccinated HCWs (77.4%) was significantly higher than that of the vaccinated general population (64.4%). The research revealed that a large proportion of the participants (89.7%) encountered rumours regarding unverified adverse effects of the COVID-19 vaccine that significantly contributed to vaccine hesitancy,. The study showed a negative impact of misinformation on vaccine uptake and could be the most significant contributor to vaccine hesitancy in future vaccine programs.
A special survey module included in the Afrobarometer Round 9 questionnaire explored citizens’ experiences and perceptions of pollution, environmental governance, and natural resource extraction. It showed that a majority of Batswana see pollution as a serious problem in their communities, with inadequate trash disposal as the most serious offender. They believe that ordinary citizens must assume primary responsibility for reducing pollution and keeping their communities clean, but they also expect “much more” from the government to protect the environment – including tighter regulation of natural resource extraction.
The Kenyan content moderators who built the Artificial Intelligence (AI) chatbot ChatGPT have filed a petition in parliament seeking a probe into the bot’s parent company OpenAI and its local moderation partner Samasource. The Sama employees allege exploitation and underpayment during the creation of the popular chatbot and want the Kenyan government to investigate and regulate the work of tech companies operating in the country. They claim they were not properly informed of the nature of the work they would be undertaking, which involved reading and viewing material that depicted sexual and graphic violence and categorizing it accordingly so that ChatGPT's AI could learn it for purposes of its future interactions with people. All through the ChatGPT training process, the workers say they were not afforded psychosocial support and that due to the exposure to the work, they have developed severe mental illnesses including PTSD, paranoia, depression, anxiety, insomnia and sexual dysfunction. Additionally, the moderators say the contract between OpenAI and Sama was terminated abruptly, sending them home despite already suffering from severe mental illness. The moderators want parliament to enact laws regulating the outsourcing of harmful and dangerous technology work and protecting workers engaged in such work.
Kounkuey Design Initiative (KDI) is a non-profit design and community development organisation that partners with under- resourced communities to advance equity and activate the unrealized potential in their neighbourhoods and cities. Involving the community in the development of the Kibera Public Space Project automatically creates a sense of care for the local community, through local ownership and management. During this process, public spaces create opportunities for learning, employment, and activism for the community. That kind of contextual and human centred thinking is transferrable. The process that was developed in Kibera has now been replicated in other parts of the world, including in the USA.
Stigma is a recognised barrier to health-seeking behaviour and a social determinant of population health. This study draws on qualitative data collected from 55 people diagnosed with Parkinson’s and 23 caregivers as part of a wider ethnographic study to explore the lived experience of Parkinson’s disease in Kenya, using the Health Stigma and Discrimination Framework as a tool to understand stigma as a process. Participants reported their lived realities of stigma, and experiences of stigma practices, which had significant negative health and social outcomes, including social isolation and difficulty accessing treatment. Ultimately, stigma had a negative and corrosive effect on the health and wellbeing of patients, highlighting the interplay of structural constraints and the negative consequences of stigma experienced by people living with Parkinson’s in Kenya. Targeted and nuanced ways of tackling stigma are suggested, including educational and awareness campaigns, training, and the development of support groups.
This study sought through focus group discussions to identify the priorities of community members of a South African township, Soweto, and describe the underlying values driving their prioritisation process, to improve nutrition in the first 1000 days of life. The authors used a modified public engagement tool: Choosing All Together which presented 14 nutrition intervention options and their respective costs. Participants deliberated and collectively determined their nutritional priorities. All groups demonstrated a preference to allocate scarce resources towards three priority interventions school breakfast provisioning, six months paid maternity leave, and improved food safety. All but one group selected community gardens and clubs, and five groups prioritised decreasing the price of healthy food and receiving job search assistance. Participants’ allocative decisions were guided by several values implicit in their choices, such as fairness and equity, efficiency, social justice, financial resilience, relational solidarity, and human development, with a strong focus on children.