Tanzania initiated the Local Government Reform Programme in 1996. The objective of the reform is decentralisation by devolution, and to strengthen local authorities' ability to deliver quality and accessible services in cooperation with local communities, civil society organisations, the private sector, and other development actors. This report describes various forms of coordination and cooperation in four districts, using maternal health as an entry point and example. Four districts with relatively low maternal mortality rates were selected: Ileje, Misungwi, Serengeti, and Moshi rural. The objective of the study is to identify if, and in what ways, these districts perform better than others when it comes to cooperation on maternal health, and to identify best practices and disseminate the practices to other districts.
Governance and participation in health
Local democracy and the involvement of local communities in the provision of social services are central issues in the local government reforms that are presently being implemented in many developing countries. At the same time, institutions that run parallel to local authorities, such as social funds and various user-committees, are established to improve accountability and participation. By focusing on actual political processes rather than administrative, legal, and fiscal aspects of decentralisation, this article traces the breakdown of two development projects in Tanzania to the existence of parallel structures, and suggests that user-committees and social funds should be integrated in local authority structures to avoid fragmentation of participation and to enhance local democracy.
Expectant mothers in Pallisa and Budaka districts have moved closer to realising their right to adequate reproductive health services, following the launch of HEPS Uganda's Community Empowerment and Participation on Maternal Health Project. The Project, falling within the empowerment, lobbying and advocacy themes of the EU's DSCBP, specifically targets expectant mothers, health care providers, district health officials and other local government leaders as well as community opinion leaders.
In the HIV/AIDS pandemic, it is older people, particularly grandmothers, who are shouldering most of the emotional and financial burden as carers. Yet their vital role is going unrecognised. This report calls for a major shift in the response to HIV/AIDS. Some of the recommendations include: public recognition of the value, contribution and rights of older women carers to reduce stigma and discrimination against them more sophisticated analysis and understanding of the role of older women and men in caring for adults and children living with HIV, so that urgent; support can be targeted at these older carers; better support to access existing services home-based care policies and programmes that address the specific economic, health and psychosocial needs of older women carers and support them in their care giving roles.
This study set out to understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice. The design was that of an ethnographic study using participant observation, interviews, and collection of documentary evidence. Set in a multiagency modernisation programme to improve stroke services in two London boroughs, participants comprised of service users, National Health Service managers, and clinicians. Author conclusions include that user involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.
There is no standard definition of a community. The term “community” has been used to describe interactions among people in primarily geographic terms. But it is now accepted that people who live in close proximity to one another do not necessarily constitute a community, since they may differ with respect to value systems and other cultural characteristics that are more relevant to the social concept of community. Some have argued that the defining feature of a community is the common identity shared by its members. Thus, a single individual may belong simultaneously to different religious, vocational, or ethnic communities, or communities with distinct values and aspirations may inhabit a single geographic area. Even though community is determined largely by shared traditions and values, communities are not static and may accommodate multiple and even conflicting interpretations of their own traditions and values. Outsiders may also define community differently from insiders. The extent to which a community reflects these features is a measure of its cohesiveness. The authors argue that different levels of community cohesiveness or specific features may warrant different research protections.
`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.
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.