Poverty and health

‘No access to sanitation’ – the big euphemism
de Albuquerque C: United Nations Special Rapporteur on the human right to safe drinking water and sanitation, 15 November 2013

The United Nations Special Rapporteur on the human right to safe drinking water and sanitation, Catarina de Albuquerque, has warned that the sanitation target set by the UN Millennium Development Goals (MDG) is today the most off-track of all, leaving around one billion people still practicing open defecation on a daily basis, and one-third of the world’s population ‘without access to improved sanitation.’ The human rights expert hailed the UN General Assembly’s decision declaring 19th of November as UN World Toilet Day. “I hope this declaration galvanises national and international action to reach the billions of people who still do not benefit from this basic human right,” the Special Rapporteur said.

‘Our land, our lives’: Time out on the global land rush
Oxfam Briefing Note: October 2012

In the last decade, enough agricultural land has been sold off to grow food for a billion people, which is equivalent to the number of people who go hungry in the world each night, according to Oxfam. Over 60% of investments in agricultural land by foreign investors between 2000 and 2010 were in developing countries with serious hunger problems. However, two-thirds of those investors plan to export everything they produce on that land. While Oxfam supports greater investment in agriculture and to small-scale producers, it argues that the unprecedented rush for land has not been adequately regulated or policed to prevent land grabs. This means that poor people continue to be evicted, often violently, without consultation or compensation. Many lose their homes and are left destitute, without access to the land they rely on. Oxfam calls on the World Bank to temporarily freeze investments involving large-scale land deals so it can review its advice to developing countries, help set standards for investors, and introduce more robust policies to stop land grabs.

‘These are not luxuries, it is essential for access to life’: Disability related out-of-pocket costs as a driver of economic vulnerability in South Africa
Hanass-Hancock J; Nene S; Deghaye N; Pillay S: African Journal of Disability 6(0), a280, 2017

Middle-income countries are home to a growing number of persons with disabilities but with limited evidence on the factors increasing economic vulnerability in people with disabilities in these countries. This article presents data related to elements of this vulnerability in one middle-income country, South Africa. Focusing on out-of-pocket costs, it uses focus group discussions with 73 persons with disabilities and conventional content analysis to describe these costs. A complex and nuanced picture of disability-driven costs evolved on three different areas: care and support for survival and safety, accessibility of services and participation in community. Costs varied depending on care and support needs, accessibility (physical and financial), availability, and knowledge of services and assistive devices. The development of poverty alleviation and social protection mechanisms in middle-income countries like South Africa should, the authors argue, better consider diverse disability-related care and support needs not only to improve access to services such as education and health but also to increase the effect of disability-specific benefits and employment equity policies

“If it's issues to do with nutrition…I can decide…”: gendered decision-making in joining community-based child nutrition interventions within rural coastal Kenya
Muraya K; Jones C; Berkley ; et al.: Health Policy and Planning 32 (Suppl 5) ppv31–v39 2017

This qualitative study undertaken in rural Coastal Kenya aimed to explore the interaction between household gender relations and a community-based child nutrition programme. It focused on household decision-making dynamics related to joining the intervention. Fifteen households whose children were enrolled in the programme were followed up over a period of 12 months. Over 60 household visits, group and individual in-depth interviews were conducted with a range of respondents, supplemented by non-participant observations. Data were analysed using a framework analysis approach. Engagement with the intervention was highly gendered with women being the primary decision-makers and engagers. Women were responsible for managing child feeding and minor child illnesses in households. As such, involvement in community-based nutrition interventions and particularly one that targeted a condition perceived as non-serious, fell within women’s domain. Despite this, the nutrition programme of interest could be categorized as gender-blind. Gender was not explicitly considered in the design and implementation of the intervention, and the gender roles and norms in the community with regards to child nutrition were not critically examined or challenged. In fact, the authors argue that the intervention might have inadvertently reinforced existing gender divisions and practices in relation to child nutrition, by excluding men from the nutrition discussions and activities and thereby supporting the notion of child feeding and nutrition as “women’s business”. To improve outcomes, community based nutrition interventions are argued to need to understand and take into account gendered household dynamics, and incorporate strategies that promote behaviour change and attitude shifts in relation to gendered norms and child nutrition.

“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda
Flax V; Yourkavitch J; Okello E; Kadzandira J; Katahoire A; Munthali A: PLOS One, doi: https://doi.org/10.1371/journal.pone.0178298, 2016

The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. The authors conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organisations supporting PMTCT as well as focus group discussions with men. They analysed the data using thematic content analysis. The authors found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands’ decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, the authors propose that Ministries of Health use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.

“Like we don’t have enough on our hands already!”: the story of the Kenyan slum youth federation
Makau J: Environment & Urbanization 23(1) 203–206, 2011

Slum dweller federations, like many other social movements, cater for the youth in their constituencies. This is critical to their relevance as agents of change and contributes to the sustainability of the movements. This story is a case study of the youth federation that is aligned to Kenya’s slum dwellers federation. At the slum level, the youth had organized themselves into junior councils that discussed various issues, like how to gain access to football pitches in neighbouring schools. When the annual Youth Council elections came around that year, for the first time slum youth showed up in great numbers and elected their own for all the posts, including junior mayor. From its beginnings in a couple of slums, the movement spread to slums in four of the city’s eight divisions, and the youth called it “Mwamko wa Vijana” (“Youth Awakening”). Three years after it was initiated, a range of activities are underway: a football team, acrobatic and dance troupes, a study group, and a waste collection business. They note: “We share issues in common that we can federate around – education, recreation, income generation and mentoring.” The prospect of renewing the youth federation every year is a daunting task but each year new youth come in that are charged up and compelling in their aspirations, so that there is little choice but to do it again.

“The hidden hunger”: Understanding the burden of anaemia and its determinants among pregnant and non-pregnant women in Ethiopia
Wondu T and Bijlsma M: Journal of Food, Agriculture, Nutrition and Development, 12(7), December 2012

The objective of this study was to assess the burden of anaemia and its determinants among pregnant and non-pregnant women in Ethiopia. Researchers used data from the 2005 Demographic and Health Survey of Ethiopia. A total of 5,960 women of child-bearing age were included in the analysis. The general prevalence of anaemia among women was 27.7%, while the prevalence of anaemia was 33% and 27.3% among pregnant and non-pregnant women respectively. Analysis revealed a significant negative association between prevalence of anaemia and women’s educational status, grouped altitude of residential places and household wealth index categories. The authors found that anaemia is a moderate public health problem among women in Ethiopia but there exist significant differences in magnitude by socio-economic status of women and their families and where they live. They call for interventions designed to address maternal anaemia that pay attention to both nutritional and non-nutritional intervention strategies, including environmental sanitation, de-worming, and provision and promotion of family planning methods.