Structural adjustment programmes of international financial institutions have typically set the fiscal parameters within which health policies operate in developing countries. Yet, a systematic understanding of the ways in which these programmes impact upon child and maternal health is currently lacking. This article systematically reviews observational and quasi-experimental articles published from 2000 onward in online databases and grey literature from websites of IMF, World Bank and African Development Bank. Studies were considered eligible if they empirically assessed the aggregate effect of structural adjustment programmes on child or maternal health in developing countries. Of 1961 items yielded through database searches, reference lists and organisations’ websites, 13 met the inclusion criteria. The authors found that structural adjustment programmes had a detrimental impact on child and maternal health. In particular, these programmes undermined access to quality and affordable healthcare and adversely impacted upon social determinants of health, such as income and food availability. According to the authors, the evidence suggests that a fundamental rethink is required by international financial institutions if low income countries are to achieve the Sustainable Development Goals on child and maternal health.
Poverty and health
In 1972, disaster struck the coal mining town of Hwange killing 427 workers following an underground explosion at the No.2 Colliery, also known as Kamandama Mine, part of Hwange Colliery. Forty-seven years later, the author reports that the widows of the victims of the Kamandama mine disaster live in neglect and abject poverty. Following the death of their husbands, they were forced out of colliery houses to pave way for new workers and their families. Many who had no relatives in town moved to rural areas. In a commemoration to remember the women’s struggles, convened by Centre for Natural Resource Governance (CNRG) and Greater Hwange Residents Trust, with the support from Open Society Initiative for Southern Africa, the surviving widows said that they are only remembered once per year, in June, when the mining town commemorate the Kamandama mine disaster. The widows called on the government and Hwange Colliery Company to compensate them and ensure they get improved access to health care. The CNRG called on the government of Zimbabwe, as the majority shareholder in Hwange Colliery Company Limited, to compensate the widows and ensure decent housing in the villages for them.
At the International Labour Conference, IMF Managing Director Christine Lagarde unveiled an institutional view on social spending that will guide Fund staff on social protection, health and education. This responds to an IMF Internal Evaluation Office report noting that the institution was increasingly out-of-step with “the rights-based approach to social protection espoused by UN agencies including the ILO.” The IMF view is primarily focused on social assistance. These benefits, generally targeted to the poorest, are often advocated by the IMF as a measure to mitigate its conditionality and policy advice including austerity and the expansion of regressive taxation such as Value-Added Taxes. The institutional view argues that regressive taxes can be offset by more progressive social transfers. The Fund’s approach to social assistance and reducing spending has led to the promotion of narrow targeting through proxy means testing in many developing countries that erroneously excludes large numbers of recipients. The difficulties of narrow targeting are acknowledged but do not result in a clear change in policy. The International Labour Conference discussion of the General Survey concerning the Social Protection Floors Recommendation No. 202 highlighted how pressures from the IMF to cut social spending and the wage bill in public sector workers and to reduce the coverage of social protection have impeded the ability of states to deliver on their commitment to deliver adequate, comprehensive social protection systems consistent with ILO standards. In the past, the IMF has been more open to social protection floors, working jointly with the ILO after 2010 to support financing of national floors. Throughout the creation of the institutional view, the ITUC advocated for the IMF to support countries in financing comprehensive social protection systems and close coordination with the ILO.
In this paper the authors sought to determine the level of men’s involvement in antenatal care and the factors influencing their involvement in these services. A cross sectional study of 966 randomly selected men aged 18 years or older was conducted in Dodoma Region, from June 2014 to November 2015. Face to face interviews were conducted using a pretested structured questionnaire. The level of men’s involvement in antenatal care was high and 89% of respondents made joint decisions on seeking antenatal care. More than half of respondents accompanied their partners to the antenatal clinic at least once. Less than a quarter of men were able to discuss issues related to pregnancy with their partner’s health care providers, although 77% of respondents provided physical support to their partners during the antenatal period. Factors influencing men’s involvement in antenatal care were occupation, ethnicity, religion, waiting time, information regarding men’s involvement in antenatal care and men’s perception about the attitude of health care providers. Overall, more than half of respondents reported high involvement in antenatal care services. Access to information on men’s involvement, religion, occupation, ethnicity, waiting time and men’s perception about the attitude of care providers were significant factors influencing men’s involvement in antenatal care services in this study. The authors observe that health promotion is needed to empower men with essential information for meaningful involvement in antenatal care services.
Worldwide, more than two million people die every year from diarrhoeal diseases. Poor hygiene and unsafe water are responsible for nearly 90 per cent of these deaths and mostly affect children. A study by the World Bank Group, UNICEF and the World Health Organization estimates that extending basic water and sanitation services to unserved households would cost US$28.4 billion per year from 2015 to 2030, or 0.1 per cent of the global product of the 140 countries included in its study. The economic impact of not investing in water and sanitation costs 4.3 per cent of sub-Saharan African GDP. The paper recommends that civil society organizations work to keep governments accountable, invest in water research and development, and promote the inclusion of women, youth and indigenous communities in water resources governance.
In Uganda 13% of persons have at least one form of disability. This study explores the maternal and newborn health related needs of women with walking disabilities in Kibuku District Uganda. A qualitative study was carried out in September 2017 in three sub-counties of Kibuku district. Four In-depth Interviews among purposively selected women who had walking disabilities and who had given birth within two years from the study date were conducted. The thematic areas explored during analysis included psychosocial, mobility, health facility and personal needs of women with walking disabilities. Data was analyzed manually using framework analysis. The authors found that women with walking disabilities had psychosocial, mobility, special services and personal needs. Psychosocial needs included, partners, communities, families’ and health workers’ acceptance. Mobility needs were associated with transport unsuitability, difficulty in finding transport and high cost of transport. Health facility needs included; infrastructure and responsive health services needs while personal maternal and newborn health needs were; personal protective wear, basic needs and birth preparedness items. Communities, and health workers need to be sensitized on these needs to meet them.
This paper investigated social networks of young women in Botswana to see if an approach based on an understanding of these networks could help with recruitment into support programmes. A national HIV trial was testing an intervention to assist young women to access government programs for returning to education and improving livelihoods. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. Social network analysis was used to identify key young women in four communities and to describe the types of people that marginalised young women turn to for support. In discussion groups, the same young women helped explain results from the network analysis. Most marginalised young women went to other women, usually in the same community and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. The authors argue that since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. while this alone may be insufficient, a combination of approaches, including, for instance, peers, door-to-door recruitment and key community informants could be explored as a strategy for reaching marginalised young women for supportive interventions.
This report summarizes the latest scientific knowledge on the links between exposure to air pollution and adverse health effects in children. It is intended to inform and motivate individual and collective action by health care professionals to prevent damage to children’s health from exposure to air pollution, a major environmental health threat. Exposure to fine particles in both the ambient environment and in the household causes about seven million premature deaths each year. Ambient air pollution alone imposes enormous costs on the global economy, amounting to more than US$ 5 trillion in total welfare losses in 2013. This public health crisis is receiving more attention, but one critical aspect is often overlooked: how air pollution affects children in uniquely damaging ways. Recent data released by the World Health Organization (WHO) show that air pollution has a vast and terrible impact on child health and survival. Globally, 93% of all children live in environments with air pollution levels above the WHO guidelines. More than one in every four deaths of children under 5 years is directly or indirectly related to environmental risks. Both ambient air pollution and household air pollution contribute to respiratory tract infections that resulted in 543 000 deaths in children under 5 years in 2016.
This paper seeks to describe obesity trends among women of childbearing age over recent decades, along with trends in over and under nutrition among children under five years of age, in sub-Saharan African countries. An ecological study with temporal trend analysis in 13 sub-Saharan African countries was carried out covering trends in nutritional status such as adult obesity, childhood overweight, low height-for-age, low weight-for-height, low weight-for-age and low birth weight. Publicly available data from repeated cross-sectional national surveys were used. The authors chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. The authors investigated women aged 15-49 years and children under five years of age. In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings. The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider both nutritional deficiencies and nutritional excess.
Just four months ago, the fishing harbour at Kachulu on the western shores of Lake Chilwa in Malawi was bustling with fishermen and traders haggling over the catch of the day. Today hundreds of fishing boats sit marooned on cracked, dry mud as vultures fly above the shores of the once productive fishing zone 30 kilometres (19 miles) east of the southern African country's old capital Zomba. Julius Nkhata, a local villager, says the increasingly dramatic seasonal dry-out of the lake -- blamed by experts on man-made climate change -- has displaced local people and increased joblessness. One-and-a-half million people live in the areas on the Lake Chilwa basin, which is one of the most densely populated areas in southern Africa. Nixon Masi, a government fishery official at Chilwa, said a women's fish-drying cooperative that depends on the lake had been devastated. "There is no fish. This has resulted in a big problem as the women from the cooperative have no source of income," he said. Of the initial 38 members, 21 have left to rebuild their lives elsewhere.