Preventing malaria by controlling mosquitoes in their larval stages requires regular sensitive monitoring of vector populations and intervention coverage. The study assessed the effectiveness of operational, community-based larval habitat surveillance systems within the Urban Malaria Control Programme (UMCP) in urban Dar es Salaam, Tanzania. Cross-sectional surveys were carried out to assess the ability of community-owned resource persons (CORPs) to detect mosquito breeding sites and larvae in areas with and without larviciding. CORPs reported the presence of 66.2% of all aquatic habitats, but only detected Anopheles larvae in 12.6% of habitats that contained them. Detection sensitivity was particularly low for late-stage Anopheles, the most direct programmatic indicator of malaria vector productivity. Whether a CORP found a wet habitat or not was associated with their unfamiliarity with the area. Accessibility of habitats in urban settings presents a major challenge because the majority of compounds are fenced for security reasons. Furthermore, CORPs under-reported larvae especially where larvicides were applied. This UMCP system for larval surveillance in cities must be urgently revised to improve access to enclosed compounds and the sensitivity with which habitats are searched for larvae.
Governance and participation in health
This book identifies four types of dynamics impact on reforms at the sector-level: sector-specific dynamics, cross-sectoral dynamics, the dynamics of the political process and country-wide dynamics. It divides approaches into two groups: sector-level political economy approaches; and country-level and politics-centred political economy approaches. Based on this analysis, the book found that sector-level political economy approaches can be characterised by a series of strengths, weaknesses and gaps. Strengths tended to be their focus on core development challenges, methodological diversity and dynamic evolution. Weaknesses, on the other hand, tended to be around having a very small number of empirical, comparable and publicly accessible sector studies; too few policy management-oriented action frameworks and an insufficient theoretical guidance on using some approaches, frameworks and matrices. Gaps were identified in the assessment of political viability of sector reforms; in the analysis of domestic decision making and subsequent implementation; and in the consideration of concrete operational implications. One of the sectors covered in this book is the health sector.
This study's aim was to explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. A total of 1,409 participants were enrolled, all female, with a median age of 45. After two years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour. In conclusion, the addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.
The objective of this project was to achieve high, sustainable levels of net coverage in a village in rural Tanzania by combining free distribution of long-lasting insecticide-impregnated nets (LLINs) with community-tailored education. Community leaders held an educational session for two members of every household addressing these practice and attitudes, demonstrating proper LLIN use, and emphasizing behaviour modification. Attendees received one or two LLINs per household. Baseline interviews and surveys revealed incorrect practices and attitudes regarding: use of nets in dry season, need to retreat LLINs, children napping under nets, need to repair nets and net procurement as a priority, with 53- 88.6% incorrect responses. A three-week follow-up demonstrated 83-95% correct responses. Results suggest that addressing community-specific practices and attitudes prior to LLIN distribution promotes consistent and correct use, and helps change attitudes towards bed nets as a preventative health measure. Future LLIN distributions can learn from the paradigm established in this project.
This book builds on eight case studies, all loosely involving financial networks such as the G20, several written by network insiders, to try and sort out whether networks are a blessing or a curse for developing countries. The contributors ask a number of questions: Are networks exciting new avenues for poor country governments and civil society to influence the big decisions, or sneaky ways to get round accountability and exclude the population through a 21st century version of invitation-only gentleman’s clubs? Will they replace or strengthen formal international institutions like the United Nations or the International Monetary Fund? Are North-South networks different from South-South ones? (both are proliferating). The book sets out five functions of networks: agenda setting; consensus building; policy coordination; knowledge exchange and production and norm-setting and diffusion. It identifies two categories of network. Advocacy networks aim to mobilise support for a cause and concentrate on the agenda-setting, norm-setting and consensus-building functions, while ‘self-help’ or ‘problem-sharing’ networks focus on improving members’ capacities through knowledge production and exchange and policy coordination.
This case study describes a multisectoral adolescent sexual and reproductive health (ASRH) programme with three main components: clinical youth-friendly health services (YFHS), inschool interventions and community-based outreach. It has been written for programme and project managers at national, district and local levels interested in the implementation and scale-up of multisectoral programmes that encompass YFHS. It outlines the process used to design, implement, monitor and evaluate the Geração Biz programme in Mozambique. The steps taken during the pilot phase and subsequent scale-up of the programme are described, as well as key lessons learned. This case study is intended to provide an example of how to design and implement a multisectoral programme that is intended to be scaled up from the beginning. Although other countries have different political, social and cultural contexts, the experience and lessons learned here could be adapted and applied to help other countries that wish to establish or scale up YFHS within multisectoral programmes.
Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. This study reports on a data-driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa. The intervention consisted of an initial assessment undertaken by a team of district supervisors, workshops to assess results, identify weaknesses and set improvement targets and continuous monitoring to support changes. Routine data revealed poor coverage of all programme indicators except HIV testing. One year following the intervention, large improvements in programme indicators were observed. Coverage of CD4 testing increased from 40 to 97%, uptake of maternal nevirapine from 57 to 96%, uptake of infant nevirapine from 15 to 68% and six week polymerase chain reaction (PCR) testing from 24 to 68%. It is estimated that these improvements in coverage could avert 580 new infant infections per year in this district.
The University of Oxford's Global Economic Governance Programme has launched an independent Expert Taskforce on Global Knowledge Governance to propose a set of principles and options for the future of global knowledge governance. The Taskforce's Honorary Advisors emphasised the scope of global knowledge governance challenges at hand. The Taskforce will be led by a small, core team of experts participating in a personal capacity, supported by several distinguished Honorary Advisors. The Taskforce will consult widely, interviewing a diversity of academics, policy experts, and stakeholder communities around the world. The report will be peer-reviewed by a group of leading international scholars working on the intersection of issues covered in the study. The findings of the Taskforce will be published in late 2010 and presented to governments, relevant international organisations, stakeholders and academics working to shape how the future of global knowledge governance unfolds.
Policy briefs are a relatively new approach to packaging research evidence for policymakers. Drawing on available systematic reviews makes the process of mobilising evidence feasible in a way that would not otherwise be possible if individual relevant studies had to be identified and synthesised for every feature of the issue under consideration. This article suggests questions that can be used to guide those preparing and using policy briefs to support evidence-informed policymaking: Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? Does the policy brief take quality, local applicability, and equity considerations into account when discussing the synthesised research evidence? Does the policy brief employ a graded-entry format? Was the policy brief reviewed for both scientific quality and system relevance?
Increasing interest in the use of policy dialogues has been fuelled by a number of factors, such as recognition that: there is a need for locally contextualised 'decision support' for policymakers and other stakeholders; research evidence is only one input into the decision-making processes of policymakers and other stakeholders; having many stakeholders can add significant value to these processes; and many stakeholders can take action to address high-priority issues, and not just policymakers. This article suggests questions to guide those organising and using policy dialogues to support evidence-informed policymaking: Does the dialogue address a high-priority issue? Does the dialogue provide opportunities to discuss the problem, options to address the problem, and key implementation considerations? Is the dialogue informed by a pre-circulated policy brief and by a discussion about the full range of factors that can influence the policymaking process? Does the dialogue ensure fair representation among those who will be involved in, or affected by, future decisions related to the issue? Are outputs produced and follow-up activities undertaken to support action?