`Participation' by community members in health-related programmes is an appealing concept that has not always been easy to achieve. Such programmes are often directed towards communities defined on the basis of neighbourhood or group identity. This article aims to develop an account of participation and identity by drawing on Bourdieu's theory of practice to understand participation as the practice of social identities structured by habitus, capital and field. Examples from interviews with members of one deprived neighbourhood illustrate the theory by showing that people may identify with their neighbourhood for certain social purposes, but have different identity practices in different fields of practice. Implications for community-based health programmes are briefly outlined.
Governance and participation in health
Social networks have been a central focus of sociological research on inequalities but less has focused specifically on chronic illness and disability despite a policy emphasis on resources necessary to support self-management. The study sought to unpack overlaps and distinctions between social network approaches and research on the experience and management of chronic illness. We outline four main areas viewed as central in articulating the potential for future work consistent with a critical realist perspective: (1) body–society connections and realist/relativist tensions; (2) the controversy of ‘variables’ and accounting for social and cultural context in studying networks for chronic illness support; (3) conceptualising social support, network ties and the significance of organisations and technology; and (4) translating theory into method.
This paper presents a synthesis of institutional arrangements and issues currently facing National AIDS Commissions (NACs) in 2007. The paper is a work in progress and is based on a literature review and informant interviews with agency-based and NAC staff and independent consultants familiar with NAC issues. It reviews the common features and emerging themes on the following topics: the background to the establishment of NACs, their governance, structure and function, financing arrangements and their role in harmonising and aligning country responses to HIV. To date, many African countries with NACs have experienced significantly improved access to, and coordination of, financial and other resources, and there is a growing diversity of funding mechanisms and a substantial increase in funding.The authors conclude that the increased pressure placed on NACs means that clarity in roles and relationships, and enabling political, legislative, policy and institutional environments are more important than ever.
Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. This paper presents experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support.
Organizations that collect substantial data for decision-making purposes are often characterised as being data rich but information poor. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for non-specialists to use such tools. This on-going project has two primary phases. This paper critically reflects on phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool.
Civil Society Organisations, especially those actively engaged with the health sector, have been largely of the opinion that the Commission constitutes a major opportunity to address key issues in the health sector. This is especially so as the Commission is seen to be engaged in examining and taking forward some of the key fundamentals of the Alma Ata declaration – viz. a Health Systems approach that foregrounds Primary Health Care and locating health in a larger social, economic and political context.
Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.
Despite acknowledged curative and preventive measures, child malaria remains a concern in many countries. Does parental empowerment and participation in control efforts offer a way forward? This review of recent literature suggests a unique approach. Successful interventions met the health promotion strategies wholly or partly. Although these interventions were sometimes incomplete, the development took into account people’s perceptions and representations. The authors acted on the belief that empowerment of parents and their participation in the development of interventions to control child malaria, is likely to yield better results and assist in reducing the prevalence of malaria morbidity and mortality in children under 5 years.
Community participation in health has been an elusive concept since the days of the Alma Ata Declaration. Many faltering steps have been taken towards genuine community participation only to be retraced because the programmes were either ill-conceived or derailed by the loss of the spirit of voluntarism. In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges. Its success has been mainly due to integration of pre-existing volunteer cadres, intersectoral approach to the monitoring of the teams and involvement of the community in the selection of the top-up team members. Its challenges include the relatively young age of the majority of the volunteers and the likely loss of financial support for the activities of the volunteers. The paper concludes that the VHT programme is a delicate venture requiring both programme support through intersectoral inputs to the Community Action Plans developed by communities and sociological approaches to educate the communities to support the VHT for its sustainability.
Members of Civil Society Organisations, trade unions, faith based organizations, student bodies and economic justice networks from the SADC region met in Lusaka, Zambia on August 15-16, under the auspices of the Southern Africa Peoples' Solidarity Network (SAPSN), to constitute the SADC People's Summit held parallel to the 27th Heads of State Summit. This document serves as the statement given on their regional theme with respect to civil society.