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.
Governance and participation in health
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.
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.
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 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.
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'.
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.
This publication is a response to the critical need for, and contribution of, collaborative partnerships with the World Health Organization (WHO) to achieve global health outcomes. It refers to WHO’s Constitution, the Eleventh General Programme of Work, 2006–2015 and the medium-term strategic plan 2008–2013, which describe collaboration and coordination as core functions of the Organization, while noting that the growth of health partnerships and other forms of collaboration have increased greatly in the past decade. It recommends that WHO develop a policy governing its engagement in, and hosting of, partnerships in a manner that avoids duplication of WHO’s core responsibilities in its partnership activities. Collaboration of WHO with stakeholders should be based on clear distinction of roles that creates added value, synergies and coordination among different programmes that support achievement of global and national health outcomes and reduce transaction costs. It calls upon United Nations member states to take the policy into account when seeking engagement by the Director-General in partnerships, in particular with regard to hosting arrangements.
Social enterprise – the use of market-based, civil society approaches to address social issues – has been a growing phenomenon for over twenty years. Gathering essays by researchers and practitioners from around the globe, this book examines, from a local perspective, the diverse ways in which social enterprise has emerged in different regions. Each chapter examines the conceptualisation, history, legal and political frameworks, supporting institutions, and latest developments and challenges for social enterprise in a given region or country. In the final chapter, the author presents a comparative analysis of the various models and contexts for social enterprise, showing how particular strengths in each environment lead to different enterprise initiative models.
Child-friendliness is a manifestation of the political will of governments to make the maximum effort to meet their obligations to respect, protect and fulfill children’s rights and ensure their wellbeing. This report has developed and used a Child-friendliness Index to assess the extent to which African governments are living up to their responsibilities to respect and protect children and to ensure their wellbeing. Three dimensions of child-friendliness were identified: protection of children by legal and policy frameworks; efforts to meet basic needs, assessed in terms of budgetary allocation and achievement of outcomes; and the effort made to ensure children’s participation in decisions that affect their wellbeing. Though child participation is important, it was not possible to obtain sufficient data on this dimension during the development of the Index. Mauritius and Namibia emerged as the first and second most child-friendly governments respectively in Africa, followed by Tunisia, Libya, Morocco, Kenya, South Africa, Malawi, Algeria, and Cape Verde. At the other extreme are the ten least child-friendly governments in Africa, the last being Guinea-Bissau preceded by Eritrea, Central African Republic, Gambia, São Tomé and Principe, Liberia, Chad, Swaziland, Guinea and Comoros.