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1.
The Community Health Worker (CHW) literature is expansive, covering more than 30 years of interest in the concept. Despite this, understanding of CHW motivation and the effectiveness of monetary incentives is limited. Using self-determination theory (SDT) as an explanatory framework, the article outlines some of the roles and functions that CHWs have filled within health and community systems, CHW motivation, and how different factors either enhance or detract from this. Agents de santé communautaires – motivation et incitations Les documents portant sur les agents de santé communautaires (ASC) sont nombreux et couvrent plus de 30 ans d'intérêt dans ce concept. En dépit de cela, la compréhension de la motivation des ASC et de l'efficacité des incitations monétaires est limitée. En utilisant la théorie de l'autodétermination (TAD) comme cadre explicatif, cet article présente quelques-uns des rôles et des fonctions que les ASC ont remplis dans le cadre de systèmes sanitaires et communautaires, la motivation des ASC et la manière dont différents facteurs soit la renforcent soit l'affaiblissent. Trabajadores de salud comunitarios - motivación e incentivos Existen numerosas investigaciones sobre los trabajadores de salud comunitarios (tsc), que abarcan los más de 30 años durante los cuales el concepto ha sido objeto de estudio. A pesar de lo anterior, las motivaciones de los tsc y la eficacia de los incentivos monetarios no son ampliamente comprendidas. Con el apoyo de la teoría de la autodeterminación como marco analítico, el presente artículo expone algunos de los roles y de las funciones desempeñados por los tsc en los sistemas de salud comunitarios, así como las motivaciones que los impulsan, analizando, a la vez, los distintos factores que alientan o desincentivan tales motivaciones. Trabalhadores comunitários da saúde – motivação e incentivos A literatura sobre Trabalhadores Comunitários da Saúde (TCSs) é extensa, abrangendo mais de 30 anos de interesse no conceito. Apesar disto, o entendimento sobre a motivação dos TCSs e da efetividade de incentivos monetários é limitado. Utilizando a Teoria da Auto-Determinação (TAD) como estrutura explicativa, o artigo apresenta algumas das tarefas e funções que os TCSs têm realizado dentro dos sistemas de saúde e comunidade, a motivação dos TCSs e como fatores diferentes melhoram ou agravam a partir disto. 相似文献
2.
ABSTRACTThe 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. 相似文献
3.
This article aims to understand whether women’s empowerment increases access to healthcare among women facing domestic violence within the Indian context. It reports on a multi-centre cross-sectional study covering 18 states of India, with 14,405 women respondents through a systematic multi-stage sampling strategy. Both quantitative and qualitative methods were used. Despite substantive possession of the existing attributes of empowerment, women fail to receive necessary healthcare services. This reflects a situation of biased policy processes and institutional frameworks, which are a manifestation of existing patriarchal norms and which result in the piecemeal processes of entitlements. 相似文献
4.
This paper introduces the special issue. It first places the protection of children in the context of development studies. It goes on to outline current international trends in the protection of children and raises questions about them. Finally, it introduces the papers in the issue and highlights how they speak to the questions raised. Introduction : développement, enfants et protection Cet article constitue l'introduction du numéro spécial. Il situe d'abord la protection de l'enfance dans le contexte des études du développement. Il présente ensuite les tendances internationales actuelles dans la protection de l'enfance et soulève des questions à leur sujet. Il présente enfin les articles figurant dans le numéro et met en relief la manière dont ils traitent des questions soulevées. Introdução: desenvolvimento, crianças e proteção Este artigo introduz a edição especial. Primeiramente, ele insere a proteção das crianças no contexto dos estudos de desenvolvimento. O artigo, então, apresenta as tendências internacionais de hoje relativas à proteção das crianças e levanta questões sobre elas. Por fim, os artigos da edição são apresentados e destaca-se como eles abordam as questões levantadas. Introducción: desarrollo, infancia y protección El ensayo que introduce este número especial comienza situando la protección de la niñez en el contexto de los estudios de desarrollo. Continúa perfilando las tendencias actuales de la protección de la niñez en el ámbito internacional y plantea dudas sobre las mismas. El ensayo concluye con una semblanza de los artículos que componen este número y se centra en cómo éstos responden a las dudas planteadas. 相似文献
5.
The paper attempts to find out fertility differential by husbands' occupational status and income level in Dhanbad district, Jharkhand (India). The mean number of children ever born (MCEB) is used to measure fertility, and monthly income as the income variable. Older and younger cohorts of women were examined separately for assessing fertility differential. MCEB was found to be high for women with husbands employed as labourers with a low monthly income. This was true for both the cohorts, but fertility levels were much higher among the older cohort. Low MCEB was found with increasing income of husbands and for those in private jobs. Différence de fécondité en fonction du statut professionnel et du revenu des maris dans le district de Dhanbad, Jharkhand, Inde Cet article cherche à établir des différences potentielles sur le plan de la fécondité en fonction du statut professionnel des maris et de leur niveau de revenu dans le district de Dhanbad, à Jharkhand (Inde). Le nombre moyen d'enfants par femme (NMEF) est employé pour mesurer la fécondité, et le revenu moyen comme variable de revenu. Des groupes de femmes jeunes et plus âgées ont été examinés séparément pour évaluer la différence sur le plan de la fécondité. On a constaté que le NMEF était élevé pour les femmes dont les époux travaillaient comme ouvriers et percevaient un revenu mensuel faible. Il en était ainsi des deux groupes, mais le degré de fécondité était beaucoup plus élevé parmi les membres du groupe des femmes plus âgées. Un NMEF plus faible a été constaté parmi celles dont les maris avaient des revenus supérieurs ou occupaient des postes dans le secteur privé. Diferencial de fertilidade pela condição ocupacional dos maridos e renda no distrito de Dhanbad, Jharkhand, Índia O artigo visa descobrir o diferencial de fertilidade em razão da condição ocupacional dos maridos e nível de renda no distrito de Dhanbad, Jharkhand (Índia). O número médio de crianças nascidas (MCEB) é utilizado para medir a fertilidade, e a renda mensal como variável de renda. Grupos de mulheres mais velhas e mais novas foram examinados separadamente para se avaliar o diferencial de fertilidade. O MCEB encontrado foi alto para mulheres com maridos empregados como trabalhadores com baixa renda mensal. Isto ocorreu em ambos os grupos, mas os níveis de fertilidade foram muito mais altos entre o grupo mais velho. Um baixo MCEB foi encontrado com a renda crescente dos maridos e para aqueles em empregos privados. La diferencial de fertilidad según el reconocimiento profesional y los ingresos de los esposos en el distrito de Dhanbad, Jharkhand, India Este ensayo busca establecer la diferencial de fertilidad según el reconocimiento profesional y el nivel de ingresos de los esposos en el distrito de Dhanbad, en Jharkhand, India. El número promedio de hijos nacidos (NPHN) se utilizó para medir la fertilidad y se estableció la variable de ingreso de acuerdo al ingreso mensual. Se examinaron por separado grupos de mujeres, jóvenes y mayores, para evaluar la diferencial de fertilidad. Se determinó que el NPHN era alto para las mujeres cuyos esposos trabajaban como obreros con ingresos mensuales bajos. Esta situación prevalecía en ambos grupos de mujeres, pero los niveles de fertilidad eran más altos para el grupo de mayor edad. Un NPHN bajo se asoció a esposos con ingresos más altos o con un empleo en el sector privado. 相似文献
6.
Women are forbidden from giving birth within the community in Dove, Ghana because it is against their culture. Such cultural practice is scarce in contemporary societies so studies on the impact of the practice are currently limited in development literature. This article uses key informant interviews and focus group discussion guides to gather data. Findings reveal that the Chief, the Queenmother, and other community members maintain that the practice is not negatively affecting the socio-economic development of Dove as they have strategies to mitigate the practice. 相似文献
7.
Implementing change is far harder than making policy pronouncements that call for change. Rwanda, in the 20 years since the 1994 genocide, has made substantial progress in turning around its economy and in meeting key Millennium Development Goals (MDGs). Real GDP in Rwanda grew at a rate of over 8% per year in the past years, the percentage of the people living in poverty has dropped by 14%, and UNDP reports that Rwanda is on track to meeting many but not all MDGs by 2015. Rwanda's progress in economic and social spheres stands out in Africa, where many countries, despite commitments to the MDGs, lag behind on performance. The difference in Rwanda is the leadership's attention to implementation, and the incorporation of endogenous practices, particularly into planning and accountability. This article is based on observations of practice at national and community levels and of policy design and implementation. It is a by-product of a study of the impact of different approaches to community health delivery systems in Rwanda, completed as part of the author's doctoral dissertation, and also of the author's experience working within the government in Rwanda. 相似文献
8.
Universal health coverage has been given a prominent place in the post-2015 global development agenda, but there are concerns over its feasibility in low- and middle-income countries. This article assesses successive Zambian governments’ efforts to achieve this agenda. We discuss the recent restructuring of health governance to support policies that re-emphasise the social determinants of health and health equity. This includes a new Ministry of Community Development and Mother and Child Health alongside the Ministry of Health. We argue that recent innovations in policy and practice need to be extended to include ministries which focus on economic development. 相似文献
9.
Based on empirical evidence from a donor-funded project in Ghana, this article demonstrates that when development implementation is depoliticised, targets will likely be achieved within budget and on time. Funded and supervised by the Millennium Challenge Corporation of the United States, Ghana Compact I has been recommended as a model for future development implementation. This article is an attempt to explain this success, compared to select social programmes. It argues that Compact I was implemented successfully because it was insulated from political interference, and suggests that donor-induced depoliticisation offers a route to successful development implementation in recipient countries. 相似文献
10.
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. 相似文献
11.
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. 相似文献
12.
This paper explores how the United Nations High Commissioner for Refugees' (UNHCR) global priorities and strategies for refugee girls and boys are applied in long-term Bhutanese refugee camps in Nepal. It examines UNHCR's interventions to prevent and respond to child protection issues, including separation from parents and caregivers, and early marriage. These are compared with community perceptions of, and assistance for, children living in difficult circumstances. Young refugees' own research on issues affecting children in the camps offers further insights into how protection is defined and experienced by children living in this context and their suggestions for community and bureaucratic responses. Priorités mondiales par rapport au contexte local : protection des enfants réfugiés bhoutanais au Népal Cet article traite de la manière dont les priorités et les stratégies mondiales de l'HCR des Nations Unies relatives aux filles et aux garçons réfugiés sont appliquées dans les camps de réfugiés bhoutanais du Népal. Il examine les interventions de l'HCR afin de prévenir et de répondre aux questions de protection de l'enfance, y compris la séparation des parents et des personnes responsables, ainsi que le mariage précoce. Elles sont comparées à la manière dont la communauté perçoit les enfants qui vivent dans des circonstances difficiles et leur apporte une assistance. Les recherches menées par les jeunes réfugiés eux-mêmes sur les enfants qui vivent dans les camps donnent des informations supplémentaires sur la manière dont la protection est définie et vécue par les enfants vivant dans ce contexte et sur leurs suggestions pour les ripostes communautaires et bureaucratiques. Prioridades globais em relação ao contexto local: protegendo crianças refugiadas butanesas no Nepal Este artigo analisa como as prioridades globais da UNHCR e as estratégias para meninas e meninos refugiados são aplicadas nos campos de refugiados butaneses no Nepal. O trabalho examina as intervenções da UNHCR na prevenção e resposta em relação às questões de proteção infantil, inclusive a separação dos pais e cuidadores e casamento precoce. Essas intervenções são comparadas com as percepções da comunidade em relação às crianças vivendo em circunstâncias difíceis e à assistência a elas. A pesquisa realizada pelos próprios jovens refugiados sobre questões que afetam as crianças nos campos oferece ideias adicionais sobre como a proteção é definida e vivenciada pelas crianças que estão vivendo neste contexto e suas sugestões de respostas comunitárias e burocráticas. Prioridades globales versus contexto local: la protección de la niñez butanesa refugiada en Nepal Este ensayo analiza cómo se aplican las prioridades y estrategias globales del ACNUR para la niñez refugiada en los campamentos de refugiados butaneses en Nepal. Examina las acciones del ACNUR para prevenir y enfrentar las problemáticas de protección de la niñez, incluyendo la separación de los padres o tutores legales y el matrimonio precoz. Se comparan estas acciones con las percepciones que tiene la comunidad sobre los niños y niñas en circunstancias difíciles y la asistencia que se les presta. Las investigaciones sobre la infancia que han realizado jóvenes refugiados en los campamentos ofrecen nuevas perspectivas sobre cómo los niños y las niñas que ahí viven definen protección, cómo la viven y qué acciones plantean a la comunidad y al gobierno. 相似文献
13.
This paper examines connections between sustainable livelihoods and the ability to deal with health risks, in the Kilombero Valley in Tanzania where rates of mortality and morbidity from malaria remain high. Application of the Sustainable Livelihoods Approach (SLA) to a narrative of daily lives demonstrates that villagers have experienced a reduction in assets, income, and capital, which limits their ability to follow health promotion advice. The focus on livelihoods highlights possible local developmental interventions that could have a significant impact on improving the health and well-being of the villagers, with potential relevance to other places in the Global South. 相似文献
14.
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. 相似文献
15.
This paper uses findings from a survey of 19 government-funded international volunteer cooperation organisations (IVCOs) to discuss whether past and future patterns of government funding provide support for assertions of neoliberal adjustments. Findings indicate greater competition between providers, increased accountability for aid effectiveness, more private sector involvement, and an emphasis on domestic priorities with a focus on the skill-development of young volunteers. It provides examples of these changes and discusses the implications of changing patterns of government funding for international volunteering as an approach to development aid. Effets des ajustements néolibéraux sur les organismes de coopération internationale bénévole financés par des gouvernements Cet article se sert des résultats d'une enquête menée parmi 19 organismes de coopération internationale bénévole (OCIB) financés par des gouvernements pour discuter de la question de savoir si les schémas passés et futurs de financement gouvernemental viennent prouver les ajustements néolibéraux. Les résultats indiquent une concurrence accrue entre fournisseurs, une redevabilité accrue pour ce qui est de l'efficacité de l'aide, une participation plus importante du secteur privé, et un accent sur les priorités nationales, avec pour axe central le développement des compétences des jeunes bénévoles. Il donne des exemples de ces changements et traite des implications de l’évolution des schémas de financement gouvernemental pour le bénévolat international comme approche de l'aide au développement. Efectos de los ajustes neoliberales en organizaciones internacionales de cooperación voluntaria financiadas por gobiernos El presente artículo se apoya en una encuesta aplicada a 19 organizaciones internacionales de cooperación voluntaria (oicv) financiadas por gobiernos, realizada con el fin de polemizar respecto a si los actuales y los pasados patrones de financiamiento gubernamental sustentan las afirmaciones de [que se produjeron] ajustes neoliberales. Las conclusiones demuestran la existencia de mayor competencia entre proveedores, así como mayor rendición de cuentas en torno a la eficacia de la ayuda, más participación del sector privado y un énfasis en las prioridades nacionales, centrado en el desarrollo de habilidades en los jóvenes voluntarios. El artículo proporciona ejemplos de estos cambios y examina las implicaciones que los cambiantes patrones de financiamiento gubernamental tienen para el voluntariado internacional como enfoque para la ayuda de desarrollo. Efeitos de ajustes neoliberais em Organizações Internacionais de Cooperação de Voluntários financiadas pelo governo Este artigo utiliza resultados de uma pesquisa de 19 Organizações Internacionais de Cooperação de Voluntários (IVCOs) financiada pelo governo para discutir se padrões passados e futuros de financiamento governamental oferecem apoio para reivindicações de ajustes neoliberais. Os resultados indicam uma maior competição entre provedores, maior prestação de contas para a efetividade da ajuda, mais envolvimento do setor privado e ênfase nas prioridades domésticas com enfoque no desenvolvimento de habilidades de jovens voluntários. O artigo oferece exemplos destas mudanças e discute as implicações de padrões variáveis de financiamento governamental para o voluntariado internacional como abordagem para a ajuda ao desenvolvimento. 相似文献
17.
Existing literature suggests that NGOs that adopt the rights-based approach (RBA) may secure more funds from rights-based donors, otherwise they would face funding cuts from such donors. This article investigates the extent to which RBA affects decisions made by ActionAid, intermediate NGOs, and CBOs on accepting certain funding conditions. Research participants from NGOs stated that RBA limits their funding because many donors prefer service delivery. They are also selective about where they apply for funds. For CBO participants, RBA posed fewer problems in terms of their funding decisions. Intermediate NGO and CBO participants claimed that RBA motivates them to locate alternative funding sources locally. 相似文献
18.
Christian health services (CHSs) provide a substantial proportion of health services in many developing countries. This paper outlines the results of research which assessed whether the financial pressures resulting from a decline in their traditional funding sources have compromised CHSs' initial motivation to serve the poor. The two main approaches CHSs used to increase their income in the 13 countries investigated were by improving their access to government funds through increased cooperation, and increasing user fees. Although some of the CHSs studied seem to be targeting more affluent patients to increase their income, the majority retain their commitment to the poor despite their financial difficulties. Les difficultés financières ont-elles compromis l'engagement des services de santé chrétiens en faveur des pauvres ? Les services de santé chrétiens (SSC) assurent une part considérable des services de santé dans de nombreux pays en développement. Cet article présente les résultats de recherches qui évaluaient la question de savoir si les pressions financières causées par le déclin de leurs sources traditionnelles de financement ont compromis la motivation initiale des SSC, à savoir servir les pauvres. Les deux principales approches suivies par les SSC pour accroître leurs revenus dans les 13 pays étudiés consistaient à accroître leur accès aux fonds gouvernementaux au moyen d'une coopération accrue et à accroître les frais à la charge des utilisateurs. Bien qu'il soit ressorti que certains des SSC étudiés semblaient en effet viser des patients plus aisés pour accroître leurs revenus, la majorité d'entre eux conservent leur engagement en faveur des pauvres malgré leurs difficultés financières. As dificuldades financeiras têm afetado a dedicação dos serviços de saúde cristãos aos pobres? Os Serviços de Saúde Cristãos (SSCs) são responsáveis por uma proporção significativa dos serviços de saúde em vários países em desenvolvimento. Este artigo apresenta os resultados da pesquisa que avaliou se as pressões financeiras resultantes de um declínio em suas fontes de financiamento tradicionais têm comprometido a motivação inicial dos SSCs de servir aos pobres. As duas principais abordagens que os SSCs utilizaram para aumentar sua renda nos 13 países investigados foram a de aumentar seu acesso a fundos do governo através de maior cooperação, e aumentar os valores cobrados dos usuários. Embora alguns dos SSCs estudados parecem estar tendo como alvo pacientes mais prósperos para aumentar sua renda, a maioria mantém seu compromisso com os pobres apesar de suas dificuldades financeiras. Las dificultades financieras de los servicios de salud cristianos: ¿han disminuido su compromiso hacia los pobres? Los servicios de salud cristianos (SSC) proporcionan un alto porcentaje de los servicios de salud en muchos países en desarrollo. Este ensayo resume los resultados de una investigación sobre los problemas financieros que acusan los SSC al disminuirse el apoyo de sus fuentes tradicionales y se pregunta si estos problemas han repercutido en su compromiso hacia los pobres. En los 13 países investigados, los SSC utilizaron por lo general dos maneras para incrementar sus ingresos: por un lado, recibieron más fondos de dependencias gubernamentales ampliando su cooperación con ellas; por otro lado, incrementaron las tarifas que pagan los usuarios. Si bien algunos SSC prefieren atender a pacientes acomodados con el fin de aumentar sus ingresos, la mayoría mantiene su compromiso con los pobres a pesar de sus dificultades económicas. 相似文献
19.
In development studies, programme sustainability has gained significant attention in recent years. One challenge to sustainability is the range of stakeholders involved in international development projects, presenting multiple perspectives and priorities, not always in harmony, nor necessarily communicated. This article presents an approach to facilitating stakeholder sustainability dialogue, an analytic framework for programme sustainability inquiry comprising five dimensions: political; economic; institutional; ownership; and practice. To demonstrate this framework we describe inquiry into stakeholder perspectives in one Afghanistan education development project. The results indicate the value of multidimensional, multiperspectival inquiry in identifying areas of potential sustainability challenge and strength. 相似文献
20.
Most African states like The Gambia use European languages for state activities and formal education. Africa has been a global pilot site for “transplanted” development initiatives with apparently consistent outcomes: failure, medium triumph, or unsustainable “success stories”. Its natural resources have been fully exploited, perhaps at the expense of resources like mother-tongue languages. Sidelining mother-tongue languages as the medium for the translation of the voice of the state, explains the gap in cultural relevance of many borrowed development initiatives, but also the neglect of workable endogenous practices. Africa must look inwards and exploit its indigenous language assets to benefit sustained development. 相似文献
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