Utilisation of maternal health services in Ethiopia: a key informant research project

This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.     

Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

Community rehabilitation workers as catalysts for disability: inclusive youth development through service learning

This paper explores access to health and education for disabled youth in sites with and without community rehabilitation workers (CRWs). A cross-sectional survey using a structured questionnaire was undertaken in nine sites in South Africa, and a snowball sample of 523 disabled youths of both sexes, aged between 18 and 35 years, was selected. The survey found that a significantly larger proportion of disabled youth living in sites with CRWs were seen by health care workers at home, and that there was a large difference in educational access between sites with and without CRWs. CRWs are well positioned to promote equal citizenship for disabled youth through service learning with occupational therapy final year students to improve access to health and education, so that barriers to their participation in economic development are removed.     

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

ABSTRACT

Despite the benefits of antenatal care, evidence from sub-Saharan Africa suggests that women often initiate these services after the first trimester of pregnancy and do not complete the recommended number of visits. This study examines the impact of mobilising faith-based and lay leaders to address the socio-cultural barriers to antenatal care uptake in northern Ghana in the context of a broader child survival project. A quasi-experimental design was used, and data were analysed using a difference-in-differences approach. The results presented in this article indicate the potential for faith-based and lay leaders to promote uptake of maternal and child health behaviours.     

A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

Faith and palliative care: a partnership of care in low- and middle-income countries

ABSTRACT

The provision of holistic palliative care has been identified by WHO as a human right, important for all people, at all ages, with all life-limiting illnesses. When faced with death and dying, issues of meaning and relationships with others, the world, and with the sacred are intensified even more in communities where faith and spiritual beliefs have a significant place. Being able to understand the significance of dying and interpreting the experience and period of living with life-limiting illness, presents an important challenge for palliative care. This article sets out the contribution that faith communities have made in understanding the significance of spiritual issues in health and in delivering palliative care in lower to middle-income contexts where palliative care has been prioritised.     

Everyday health security practices as disaster resilience in rural Bangladesh

Health security is a relatively new concept in terms of how it is practised in disaster-prone locales. We observed 10 rural households in Bangladesh for four months using informal interviews, field diaries, and observation. The findings suggest that the everyday practises of health security involve the capabilities of “caring for themselves” in resource-constrained contexts. Understanding how households care for themselves prior to and during disasters presents an opportunity to examine how improved health might reduce the effects of disasters, ill health, and poverty. Some interventions are proposed to improve health security for poorer households in general and women in particular.     

A logistics support framework: a systems-based approach to logistics planning for development projects

Logistics support plays a critical role in the delivery of quality health care services, particularly in developing countries. This study utilised systems methodology and Integrated Logistics Support (ILS) analysis to develop a support framework for a Vision Centre in rural Vietnam. The methodology employs elements of both “soft” (in particular Checkland's Soft Systems Methodology approach) and “hard” systems practices to develop an accessible and robust logistics planning tool.     

“I know! I live here”: poor women and the work of empowerment

To trace the effects of empowerment programmes in the Global South, attention needs to be focused on the everyday practices of frontline staff, or fieldworkers, who convey empowerment ideas and practices at the grassroots. This is especially critical when fieldworkers work in the marginalised communities where they also live. Instead of looking outward towards a programme’s outcomes, this article turns inward to examine the impact of women fieldworkers’ dual experiences of development on their decisions and practices in the field. The ethnography of women fieldworkers in a government-led women’s empowerment programme for the poor in Delhi, India reveals the uneasy relationship of women’s empowerment to the larger contradictory development paradigm that they work within. Fieldworkers used their experiences as poor women to meet programme quotas, while also side-lining social change in favour of shielding clients from ineffective programme activities.     

Mining revenue and access to health care in Africa: could the revenue drawn from well-managed mining sectors finance exemption from payment for health?

Various reforms undertaken during the 1980s significantly reduced the capacity of states to regulate health systems. Of the many policies implemented since then to increase access to health care, policies of exemption from direct payment are among the most important. These can be very effective in a well-funded and managed context. Beyond political will, are African states unable to afford policies of exemption from payment for health care? Our analysis, based mostly but not exclusively on research carried out in West Africa, leads us to suggest the importance of a well-managed extractive sector in Africa as a potential source to finance policies of exemption from payment for health care. This could come about if all actors concerned, whether from the private sector or the donor community, were required to follow the same rules and requirements of transparency and accountability being asked of the countries concerned.     

Assessing the impacts of a peer-to-peer training programme for women in Peru

This article reports on research that aimed to assess the economic and social impacts of a peer-to-peer training programme targeted to women in Peru, looking at overall and differentiated impacts according to design features, on a sample of 300 women in participant and non-participant communities. The study found significant positive impacts on women’s time devoted to work outside the house and in their saving propensity, although no significant change on time allocated to domestic activities. It also detected some effects on an index of family cohesion and on home improvements. Finally, there was evidence that some design features influence the magnitude and significance of these impacts.     

Micro-enterprise development initiatives and entrepreneurial competencies,innovativeness, and social capital in Malaysia

This article examines the effect of participation in development programmes designed for women micro-entrepreneurs on the development of entrepreneurial competencies, innovativeness, and social capital. The study employed a cross-sectional design and quasi-experimental approach, and collected data from 417 women micro-entrepreneurs in Malaysia. Findings reveal that the participants possess a significantly higher level of social capital, innovativeness, and entrepreneurial competencies. Development organisations should therefore focus on redesigning their policies and programmes to improve the breadth and depth of the development programmes that they offer, which ultimately lead to an improvement in the social-economic condition of low-income households in Malaysia.     

Reproductive health services: “Business-in-a-Box” as a model social innovation

Access to reproductive health services and products in remote and rural communities is a critical area of concern for developing countries. This article considers a pilot intervention in three districts of Pakistan where “Business-in-a-Box” as a model of place-based social innovation is used to improve the socio-economic conditions of women in remote rural settings through socially responsible micro-franchising. It finds that such programmes help build a sense of community, ownership and grassroots capabilities and skills. The article also discusses the impacts of such actions on the individual and community life, and the need to upscale and sustain these initiatives.     

Lessons of endogenous leadership in Nigeria: innovating to reduce waste and raise incomes in the cassava processing and goat-keeping systems

Agricultural innovations are increasingly emerging from African research scientists. This paper looks at an innovation developed by animal scientists at the University of Agriculture Abeokuta in Nigeria. They identified a method for drying cassava peels, which creates an income source for rural women, reduces environmental waste, and raises the income of goat herders by transforming the cassava waste into animal feed. Initially funded by a World Bank grant, this paper addresses the challenges of securing donor funding for local innovations and presents an argument for a new model of development that supports locally driven solutions to current development issues.     

Beyond toilets and targets: sanitation mission in India

In an attempt to address Sustainable Development Goal 6, the Government of India’s initiative, Swachh Bharat Mission (SBM), aims to make India open-defecation free by 2018. This viewpoint analyses the consequences of SBM from the perspective of women and water in the context of toilets. With the construction of toilets for 2.4 million people, the vulnerability of women is expected to worsen as available water is scarce. The viewpoint concludes that construction of toilets as a target is difficult to achieve and sustain without green technology design that overcomes the constraints of water and women.     

Intersection of disability and gender: multi-layered experiences of Ethiopian women with disabilities

This article explores the intersection of disability and gender through the experiences of Ethiopian women with disabilities using household chores as an example. As these women are often hidden at home, little literature is available on them. Thus this article aims to highlight the lived experiences of women with disabilities who are or have been at home. The interviewed women introduce peer support as an important means to increase their self-esteem and face stigma in their daily lives in a positive manner through dialogue and negotiation. The paper further suggests employing women with disabilities as a means to enable them to play a significant role in development cooperation by changing the status quo towards equality.     

National human rights action plans: a roadmap to development

Applying the “human rights-based approach to development” (HRBAD) in practice is the biggest challenge facing advocates of human rights and development. This article seeks to bridge between. HRBAD at a theoretical level and the National Human Rights Action Plans (NHRAP) at a practical level in order to not merely provide a tool for putting HRBAD into practice but also to prepare a theoretical foundation for NHRAPs. To integrate HRBAD into NHRAPs, the whole conceptual space of development is mapped into a matrix called a “Substantive-Procedural Matrix of Development” (SPMD). This matrix helps states develop their plans within the road to development. The utility of this matrix as a heuristic will be demonstrated in the case of the right to health.     

The face of development aid: volunteers and their hosts in southern Israel

The current scholarship on development aid has asserted that a “transformation” of development, one that “puts people first”, is presently taking place in the particular form of volunteer aid. In southern Israel, this claim is evident in recent attempts to “strengthen” depressed “development town” communities through a movement that combines Zionist settlement with the volunteer aid of university students. Based on ethnographic work in the development town of Yeruham, this article problematises this claim by investigating the daily encounter of volunteers with members of their multiply marginalised host community. It challenges such claims of “transformation” and exposes the complex social reality of what it means to “develop” and “empower” a population routinely framed as disadvantaged and targeted for aid.     

Management and safety of a medical mission: occupational hazards of volunteering

Medical aid missions involve travel to conflict or danger zones, posing safety risks in addition to the usual occupational risks arising from daily medical work. The note reports on a volunteer mission, using personal reports, anecdotal experiences, and the formal annual report to undertake an assessment similar to worksite assessments for hazards and control measures. Hazards were found to be prevalent, including physical noise and heat, infectious exposure from patients and local vectors, poor water sanitation, and psychosocial stress from unfamiliar environments and large patient numbers with limited means. Implementable preventative measures include increasing awareness with appropriate protective equipment usage and safety guidelines. Mission planning and management should also involve occupational health input.