Measuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation. Spatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. Four variants of the dissimilarity index were used to estimate geographic inequality in access to both services using large and small area units in each country through a cross-sectional, ecological study. Inequality was greatest for piped water in South Africa in 2001 and lowest for access to an improved water source in Uganda in 2008. For sanitation, inequality was greatest for those lacking any facility in Kenya in 2009 and lowest for access to an improved facility in Uganda in 2002. Although dissimilarity index values were greater for smaller area units, when study countries were ranked in terms of inequality, these ranks remained unaffected by the choice of large or small area units. International comparability was limited due to definitional and temporal differences between censuses. This five-country study suggests that patterns of inequality for broad regional units do often reflect inequality in service access at a more local scale. This implies household surveys designed to estimate province-level service coverage can provide valuable insights into geographic inequality at lower levels.
Poverty and health
Food shortages are the root cause of poverty in Zimbabwe’s Gutu district. Rainfall is generally low and erratic. In most places the soil is sandy and over-cultivated. High population density means that the vast majority of the district’s 40,000 households are restricted to farming on small plots. By the mid-2000s the effect of an economic crisis on the government’s agricultural budget and an over-reliance on growing maize, a crop that requires high rainfall, had drastically undermined food security in Gutu. Following a severe drought in 2005, the Chinyika Communities Development Project was conceived to overcome the persistent threat of food shortages – and even famine – in Gutu. The objective was to persuade farmers dependent on maize production to plant finger millet, a neglected crop that is indigenous to Zimbabwe. Finger millet is drought-resistant and better suited to semi-arid and arid areas than maize. Although its cultivation is more labour-intensive, it requires fewer expensive inputs than maize. It is also highly nutritious and can be stored for up to 25 years. By 2014 almost every household in Gutu had participated in the project. Farmers with a nucleus of finger millet production each have 3-5 years of strategic food reserves and the collective capacity to produce a surplus of up to 2,000 tons a year. Accumulated reserves of finger millet exceed 20,000 tons. Families in Gutu now have a stable, dependable supply of food. This has been achieved without any external intervention or funding. The success of the Chinyika Communities Development Project was grounded in participatory research, community engagement and local ownership. The narrative is about much more than switching from one crop to another. A stable supply of food – and behavioural change – has imbued farmers with the confidence to pursue various income-generating activities. In Gutu, finger millet has been the key to the emergence of a diversified and innovative family farming system.
Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash transfers is an issue of controversy. This article sets out to investigate the overall buy-in of conditions by different stakeholders and to identify pathways that contribute to an acceptability of conditions. The article draws on data from a cluster-randomized trial of a community-led cash transfer programme in Manicaland, eastern Zimbabwe. The study found a significant and widespread acceptance of conditions primarily because they were seen as fair and a proxy for good parenting or guardianship. In a socio-economic context where child grants are not considered a citizen entitlement, community members and cash transfer recipients valued the conditions associated with these grants. The community members interpreted the fulfilment of the conditions as a proxy for achievement and merit, enabling them to participate rather than sit back as passive recipients of aid.
From Africa and Asia to Latin America and the Near East, there are 805 million people in the world who do not get enough food to lead a normal, active life. The World Food Programmae downloadable Hunger Map provides information that maps the distribution of food insecurity globally.
Several non-governmental organisations (NGOs) in Malawi and consumer watchdogs have demanded a total ban on the sale of liquor spirit sachets, which they blame for fueling alcohol abuse among the youth. Consumers Association of Malawi executive director, John Kapito, states that, “Malawians are poor, so the most attractive recreational drug they can afford is liquor in sachets. Sadly, these sell at less the cost of a lottery ticket.” Liquor sold in small sachets was first outlawed in the Southern African country in May of 2013, but the move was appealed by manufacturers and since then, liquor sachet sales have risen, resulting in more youth becoming dependent on alcohol – and some dying after taking too many on an empty stomach
Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries areargued by the authors to be a reminder of the need for implementation of Global One Health in low- resource settings is crucial. This review highlights advances in key zoonotic disease areas and the One Health capacity needs.
A global discussion regarding how to renew the Millennium Development Goals (MDGs) is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities. This qualitative study used focus group discussions and key informant interviews with older people in Uganda’s Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings. Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available.
The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.
In South Africa lone mothers of working age are only entitled to social assistance for themselves if they are disabled. A means-tested Child Support Grant is payable on behalf of their children but, though important, it is small in amount and is not intended to contribute to the caregiver's living expenses. In the context of South Africa’s Constitution which declares that ‘everyone has the right to have their dignity respected and protected’ and that access to social security is to be progressively realised, this project explored the meaning of dignity in lone mothers' lives and the extent to which social security protects or erodes their dignity. The themed reports of the project cover the definition of lone motherhood in South Africa, the impact of poverty and inequality on lone mothers in South Africa and social security and the dignity of lone mothers in South Africa.
The Fifth Assessment Report of the Inter-governmental Panel on Climate Change (IPCC) finds, beyond reasonable doubt, that the Earth’s climate is warming. Climate change will have widespread impacts on African society and Africans’ interaction with the natural environment. Since the 1950s, the rate of global warming has been unprecedented compared to previous decades and millennia. The Fifth Assessment Report presents a long list of changes that scientists have observed around the world. Since the mid-19th century, the average increase in the temperature of the Earth’s surface has been 0.85 degrees Centigrade(°C). Sea levels have risen faster than at any time during the previous two millennia. In many regions, including Africa, changing rainfall or melting snow and ice are altering freshwater systems, affecting the quantity and quality of water available. The IPCC finds that there is 95% scientific certainty that human activity, by increasing concentrations of greenhouse gases in the atmosphere, has been the dominant cause of the observed warming since the mid-20th century. The impacts of climate change will affect food security, water availability and human health in Africa significantly. Given the interdependence between countries in today’s world, the impacts of climate change on resources or commodities in one place will have far-reaching effects on prices, supply chains, trade, investment and political relations in other places. Thus, climate change will progressively threaten economic growth and human security.