This study was implemented in central Malawi in 2017 to understand the different roles that Malawian men and women play in child nutrition. It involved interviews (76), focus group discussions and in-depth interviews. The authors found that women carried a disproportionate workload in supporting child nutrition compared to men, and that their heavier workloads in other areas often prevented them from being able to meet children’s food needs. There were some shifts in gender roles with men taking up responsibilities typically associated with women, but this did not necessarily increase women’s power within the household. Women continued to be primarily responsible for the food, care, and health of the household. The authors suggest that improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.
Poverty and health
Women in Informal Employment: Globalizing and Organizing (WIEGO) is a global network focused on empowering the working poor, especially women, in the informal economy to secure their livelihoods. WIEGO implemented this study in two rounds to capture changes across the different stages of the crisis during the second and third quarters of 2020, and how workers adapted by the first quarter of 2021. The study was implemented in 12 cities, including Dar es Salaam in Tanzania and Durban in South Africa. The work provides a platform to give visibility to the experience and voices of informal workers in policy. The organizations of informal workers involved in the study called for continuing relief, inclusive recovery and longer-term reforms for informal workers going forward. These demands, with concrete examples, were categorized into a common framework. a “Summary of Demands” to support these and other organizations of informal workers in their on-going advocacy and negotiations for a full and just recovery and for a “better deal” in the future for informal workers.
This paper presents parents’ perspectives on the application of the community dialogue approach in addressing adolescents’ early pregnancy and school dropout in a 2018 cluster randomized controlled trial in rural Zambia. The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators’ interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their sexual and reproductive health values and subsequently made them feel able to communicate about sexual and reproductive health issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children.
The authors examined the influence of disability and socio-demographic factors on households’ health financial risks in Uganda, using nationally representative cross-sectional data for 19305 households from the 2016 Uganda Demographic and Health Survey. Financial risk was measured by money paid for health care services. Almost 32% of households paid money for health care services access, among which 32% paid through out-of-pocket. Almost 41% of household heads were affected by disability. The majority of families went to the public sector for health care services. The mean age was 45 years. The findings indicated that disability is significantly associated with the household financial risk, as is a choice to use private sector health care services. The authors recommend identifying families with disability and those experiencing difficult living conditions for health authorities to enhance health coverage progress.
Water, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviours will disseminate this information to their families. School-based programs rely on students to act as “agents of change” to translate impact from school to home. The authors conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to assess this with students in grades 1–4, using in-person interviews with students, their teachers and caregivers. Student knowledge increased significantly, but primarily among students in grade 1. Students reporting sharing messages from the intervention with caregivers rose from 7% to 23%, particularly in students in grade 4. The authors propose that future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than applying a single approach for a wide range of ages and contexts.
The authors assessed the availability of water, sanitation and hygiene and standard precautions for infection prevention in 16456 health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location and managing authority, using data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries. Across countries, an estimated 88% had an improved water source, 94% had an improved toilet, 74% had soap and running water or alcohol-based hand rub, and 17% had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was better at health facilities than households. Availability of water, sanitation and hygiene services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries, with improvement essential to minimize the risk of COVID-19 transmission.
The authors explored the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces through in-depth interviews and focus group discussions with 165 adult women and men in five drought-affected districts, and key informant interviews with civic leaders and healthcare providers. Across districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or resorted to purchasing health commodities, including for family planning, from private retail pharmacies when unavailable from government facilities. Women expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient.
A mixed-methods longitudinal cohort study conducted among informal women workers in Kwazulu-Natal, South Africa between July 2018 and August 2019 and a photovoice activity with groups of participants to explore the childcare environment explored informal-sector working women's experience of child care. Women returned to work soon after the baby was born, often earlier than planned, because of financial responsibilities to provide for the household and new baby. They had limited childcare choices and most preferred to leave their babies with family members at home, as the most convenient, low-cost option, or mothers paid carers or formal childcare. Formal childcare was reported to be poor quality, unaffordable and not suited to the needs of informal workers. Mothers expressed concern about carers’ reliability and the safety of the childcare environment. Flexibility of informal work allowed some mothers to adapt their work to care for their child themselves, but others were unable to arrange consistent childcare, sometimes leaving the child with unsuitable carers to avoid losing paid work. Mothers were frequently anxious about leaving the child but felt they had no choice as they needed to work. Maternity protection for informal workers would support these mothers to stay home longer to care for themselves, their family and their baby, and good quality, affordable childcare would provide stability for mothers and give children the opportunity to thrive.
This report provides a comprehensive summary of global progress on improving water, sanitation, hygiene, waste management and environmental cleaning (WASH) in health care facilities and is intended to stimulate solution driven country and partner actions to further address major gaps. It provides practical steps to improving WASH in health care facilities, selected country case studies illustrating bottlenecks, gaps, and successful strategies, and recommendations for addressing gaps and sustaining services.
Covid-19 has again demonstrated the significance of safe, accessible and affordable water for all and the enormous disparities in service provision while at the same time dealing a blow to public water and sanitation operators around the world due to massive drops in revenues, rapidly rising costs and concerns about health and safety in the workplace. This book provides the first global overview of the response of public water operators to this crisis, shining a light on the complex challenges they face and how they have responded in different contexts. It looks specifically at ‘public’ water and asks how public ownership and public management have enabled (or not) equitable and democratic emergency services, and how these COVID-19 experiences could contribute to expanded and sustainable forms of public water services in the future