This compilation includes peer reviews on government accountability from Kenya and South Africa. The Kenyan review concluded that, while the reviewing process yielded a lot of data it was not as empowering and inclusive as it should have been and did not foster significant dialogue between Kenya’s government and its people. This was in part due to the way the self-assessment was carried out and also because it was focused on the efficiency and effectiveness of government, and not democratic decision-making and human rights. The South African review concluded that, while the reviewing process had many strengths, it had too great a level of government control, an overly ambitious timetable, and lacked meaningful civil society input.
Governance and participation in health
The African Peer Review Mechanism: A compilation of studies of the process in nine African countries
Open Society Initiative for Southern Africa (OSISA): 2010
Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda
Mukanga D, Tibenderana JK, Kiguli J, Pariyo GW, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G and Kallander K: Malaria Journal 9(203), 13 July 2010
This study assessed community acceptability of the use of rapid diagnostic tests (RDTs) by Ugandan CHWs, locally referred to as community medicine distributors (CMDs). The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. The study found that CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred. Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support.
Community HIV drug distribution improves adherence
Plus News: 7 July 2010
Local East African programmes are discovering the benefits of bringing HIV services closer to rural communities, with mobile drug distribution improving HIV-positive patients' adherence to antiretroviral treatment (ART). Health facilities in rural areas are normally remote, but by using mobile care and treatment centres, it is easy to reach populations who may not otherwise have access to services, according to the Support for International Change (SIC), a local HIV-focused non-governmental organisation in Tanzania. SIC reports using mobile drug distribution in northern Tanzania and witnessing a reduction of cases lost to follow up, compared to local health facilities that are recording higher levels of drop-out amongst patients. Patients must visit a hospital for their initial diagnosis and ART prescription, and are required to visit the health centre periodically, but in between visits, SIC uses community-based volunteers and trained medical workers to drive around villages refilling prescriptions as well as providing education on condom use and the prevention of opportunistic infections. SIC in Tanzania reaches nearly 2,500 people with mobile ART clinics and has so far trained around 200 health workers in Babati District in northern Tanzania.
Community-directed interventions for priority health problems in Africa: Results of a multicountry study
CDI Study Group: Bulletin of the World Health Organization 88: 509-518, July 2010
The community-directed intervention (CDI) strategy is an approach in which communities themselves direct the planning and implementation of intervention delivery. This CDI study involved multi-disciplinary research teams from seven sites in three African countries, including Uganda. Integrated delivery of different interventions through the CDI strategy proved feasible and cost-effective where adequate supplies of drugs and other intervention materials were made available. Communities, health workers, policy-makers and other stakeholders were quite supportive and their buy-in to the CDI approach increased significantly over time. Since intervention coverage also increased as more interventions were gradually included in CDI delivery, the results of the study are promising in terms of the sustainability of the CDI approach. Based on its findings, the study recommends that CDI approaches be adopted for integrated, community-level delivery of appropriate health interventions in the 16 African countries with experience in community-directed treatment for onchocerciasis control. This may comprise the interventions tested in this study, especially for malaria, or other intervention packages chosen on the basis of the lessons learnt.
Help a phone call away for sex workers
Langa L: Health-e News, 5 July 2010
South Africa’s Sex Workers Education and Advocacy Taskforce (SWEAT) and Sisonke have launched a helpline for commercial sex workers. The line was initiated to give commercial sex workers a platform to voice the concerns and fears they face at work. SWEAT noted that it was not easy for commercial sex workers to get adequate information because they are often scared of revealing what they do to earn a living. The line could also be used by anyone who wanted to get information about the industry. The line opened at the beginning of June and provides assistance on sexual health, drug and alcohol problems as well as emotional and work related matters. Those with e-mail access can also send e-mails. Commercial sex workers needing assistance would be assisted by trained counsellors from 9 am to 5pm with plans to upgrade the line to a 24-hour facility.
Open letter to UN Secretary General from civil society
United Nations: 23 June 2010
Civil society activists and anti-poverty campaigners from around the world have personally delivered a letter containing recommendations for a breakthrough plan to end poverty and inequality to United Nations (UN) Secretary-General, Ban Ki-moon. The open letter was signed by more than 120 civil society organisations, including Global Call to Action Against Poverty (GCAP), the Feminist Task Force, CIVICUS, End Water Poverty and the International Trade Union Confederation. It contains nine key recommendations, including calls for greater accountability, measures to increase gender equality and reduce social exclusion and the provision of quality affordable public services. GCAP affirmed that signatories to the letter were determined to ensure that the breakthrough plan is developed further and implemented to meet the Millennium Development Goals (MDGs). The campaign is intended to be extended to all UN member states, as well as to the United Nations Summit, which will be held in September and is expected to produce additional pledges to achieve the MDGs.
Perceptions of rewards among volunteer caregivers of people living with AIDS working in faith-based organisations in South Africa: A qualitative study
Akintola O: Journal of the International AIDS Society 13(22), 14 June 2010
This study aims to fill a research gap regarding the positive health and socio-economic outcomes and experiences of volunteers in the home-based care context in South Africa. It investigated the perception of rewards among volunteers working in home-based care settings. Qualitative interviews were conducted with a purposively selected sample of 55 volunteer caregivers using an interview schedule containing open-ended questions. The study found that volunteer caregivers derived intrinsic rewards, related to self-growth and personal development, which were a direct consequence of the experiences of caring for terminally ill patients with AIDS. Extrinsic rewards came from appreciation and recognition shown by patients and community members. The greatest sources of extrinsic rewards were identified as the skills and competencies acquired from training and experience while caring for their patients, and volunteers' ability to make a difference in the community. The insights revealed by this study may be useful to programme managers in recruiting and assisting volunteers by helping managers to identify and reflect on rewards in the caregiving situation as a means of reducing the burden of care and sustaining volunteer interest in caregiving.
The experiences of people living with HIV/AIDS and of their direct informal caregivers in a resource-poor setting
Majumdar B and Mazaleni N: Journal of the International AIDS Society 13(20), 11 June 2010
The purpose of this study was to explore and describe the challenges faced by people who are living with HIV or AIDS (PLWHAs) and their caregivers in resource-poor, remote South African villages. In-depth interviews were conducted with nine PLWHAs and their direct informal caregivers. Interviews explored the themes of physical, emotional and social wellbeing. Two focus groups were also conducted. The results of the study underscored the needs of PLWHAs and the needs of their direct informal caregivers, which include physical/medical, social, material, financial, instrumental and physiological/emotional needs, as well as gender issues. In developing home-based care programmes, the study argues that it is vital to consider the perceived needs of PLWHAs and their caregivers. The results from this study may serve as a basis for the development of a home-based care programme in similar remote and resource-poor settings.
A new twist in the conditionality tale: Using budget support to foster good political governance
Hayman R: Centre for African Studies, Edinburgh, April 2010
The provision of aid directly to government, known as direct budget support, has recently been promoted as the best possible tool for improving the impact of aid and ensuring governments take the lead in implementing national development strategies. However, this paper argues that nothing in the theory of budget supports suggests that it can or should be used as an instrument for influencing political processes. Yet over the last decade, budget support has repeatedly been subject to delays and halts, sometimes for political reasons. While these are often due to administrative problems on the funder's side, the number of incidents of budget support being halted in response to digression from democratic norms by recipient countries is on the rise. This paper questions the theories and conditions underpinning budget support. It appears that external funders are quite prepared to use conditionalities. However, to date, there is little evidence to suggest that these conditionalities bring about democratic change in the recipient country. Rather than budget support becoming a viable instrument for fostering better political practice, it would appear that there is a tightening of selectivity criteria in deciding who gets budget support and that these incidents represent the weeding out of a few 'bad apples'.
Namibian civil society calls for public health system reform
Jacobs C: AllAfrica.com, 4 June 2010
Civil society organisations in Namibia have called for reforms in the country's public health system after a case of women who were allegedly sterilised without their consent has come to court. According to the coordinator of the AIDS Law Unit of the Legal Assistance Centre, Amon Ngavetene, the redress sought is for reform in the country's health system, and particularly training and supervision of medical staff on the rights of patients.