The percentage of HIV treatment and prevention services in Kenya provided by faith-based health providers

ABSTRACT

Although the percentage of health services provided by the faith-based sector in sub-Saharan Africa is often cited along a range from 30% to 70%, depending on the country, such citations tend to be anecdotal and without reference to actual analysis of health service data. This article reports on a secondary analysis of health service data in Kenya to determine the percentage of HIV services provided by faith-based health providers. It then discusses the contributions of faith-based providers in light of these data, identifying opportunities and challenges involved in efforts to ensure that the resources of the faith-based sector are maximised.     

Assessing food insecurity in Botswana: the case of Gaborone

The search for appropriate tools to assess food and nutrition insecurity is a major preoccupation for development practitioners. This paper explores the potential of complementing a mainstream measure of food security, the Household Dietary Diversity Score (HDDS), with a political ecology approach, using a case study from Gaborone, Botswana. HDDS exposes differential food access, illustrated by varying household dietary diversity scores and commonly accessed food groups, while a political ecology approach helps explains how and why households lack access to certain food groups. HDDS enriched with political ecology analysis will provide more useful conclusions to practitioners and policymakers.

L'évaluation de l'insécurité de l'alimentation au Botswana : le cas de Gaborone

La recherche d'outils appropriés à l'évaluation de l'insécurité de l'alimentation et de la nutrition est pour les praticiens du développement une préoccupation majeure. Moyennant une étude de cas de Gaborone au Botswana cet article examine le potentiel d'une liaison entre une méthode traditionnelle pour mesurer la sécurité de l'alimentation, HDDS (Taux de Diversité de Diététique Familiale) avec une démarche basée sur l'écologie politique. HDDS expose l'accès différentiel à l'alimentation, illustré par les taux variables des diététiques familiales et par la fréquence d'accès aux groupes nutritionnels. Le HDDS, enrichi par une analyse de l'écologie politique, fournira des conclusions plus utiles pour les praticiens et pour les décideurs.

Evaluando la inseguridad alimentaria en Botsuana: el caso de Gaborone

La búsqueda de métodos apropiados para evaluar la inseguridad alimentaria y la nutrición constituye una preocupación importante entre los operadores de desarrollo. A partir de un caso de Gaborone, Botsuana, el presente artículo examina el potencial de complementar la Calificación de Diversidad en la Dieta del Hogar (cddh), medida común de seguridad alimentaria, con un enfoque de ecología política. Mientras la cddh revela la existencia de un acceso diferenciado a los alimentos, lo cual es evidenciado por las distintas calificaciones de diversidad en la dieta y por los grupos de alimentos que comúnmente se adquieren, el enfoque de ecología política ayuda a explicar cómo y por qué los hogares no tienen acceso a ciertos grupos de alimentos. Por lo que, en combinación con un análisis de ecología política, la cddh arrojará conclusiones que resulten de mayor utilidad para los operadores y los formuladores de políticas en este sentido.

Avaliando a insegurança alimentar em Botsuana: o caso de Gaborone

A busca por ferramentas adequadas para avaliar a insegurança alimentar e nutricional é uma grande preocupação para os que atuam da área de desenvolvimento. Este artigo explora o potencial de se complementar uma medida convencional da insegurança alimentar, a Pontuação da Diversidade Alimentar da Família (Household Dietary Diversity Score - HDDS), com uma abordagem de ecologia política, utilizando um estudo de caso de Gaborone, Botsuana. A HDDS mostra um acesso a alimentos diferente, ilustrado por pontuações variáveis da diversidade alimentar da família e grupos de alimentos comumente acessados, enquanto uma abordagem de ecologia política ajuda a explicar como e por que as famílias não têm acesso a certos grupos de alimentos. A HDDS, enriquecida por uma análise de ecologia política, oferecerá conclusões mais úteis para atuantes da área prática e formuladores de políticas.     

High food prices in urban Cameroon: coping strategies and suggested policy actions

Governments tend to focus on short-term policies to address the immediate effects of high food prices when spikes occur, while in the long term, urban residents are left to their own devices struggling to ensure adequate household food consumption. Using data collected in three cities in Cameroon among 300 households, this article documents participants’ opinions on appropriate policies to address high food prices as well as how households cope with chronic high food prices. It emphasises the importance of long-term government strategies such as improved farm-to-market roads and agricultural sector supports as means to improve food security.     

Strengthening public health supply chains in Ethiopia: PEPFAR-supported expansion of access and availability

When the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported Supply Chain Management System (SCMS) programme began working in Ethiopia in 2006, the estimated population of people living with HIV exceeded one million, while only 24,000 were on treatment and only 50 treatment sites were in operation. SCMS and other key partners entered into this context to support the Ethiopian government in significantly strengthening the public health supply chain system, with the aim of increasing the availability and accessibility of pharmaceutical products. The country now has 1,047 treatment sites and is nearing complete treatment coverage. This article discusses how priorities were set among many competing challenges from 2006 until 2014, and how the four-step strategy of build, operate, transfer, and optimise has resulted in a successful partnership.     

Promoting country ownership and inclusive growth? An assessment of Feed the Future

This article investigates the level of country ownership and inclusivity in Feed the Future (FtF) projects in Ethiopia, Ghana, Haiti, Senegal, and Tanzania. It finds that though interventions largely align with country-defined priorities and plans, other aspects of country ownership – consultation and provision of aid through local systems – are weaker than expected. Regarding inclusion, FtF is to some extent exclusive, perhaps as an unintended consequence of alignment with national development plans that do not reasonably promote equity. Focus is mostly on productive areas and ‘market-ready’ smallholders. The article suggests policy actions needed to better achieve expected results.     

Evolution of input supply and service hubs in dairy development at Ada'a milk shed in Ethiopia

Efficient input supply and service delivery may call for a hub approach where all the necessary inputs and services are supplied in a coordinated manner, either by a single supplier or by several and separate entities in a given geographical location accessible to beneficiaries. Based on experience from Ada'a milk shed in central Ethiopia, this paper assesses the evolution of input supply and service provision in the dairy sub-sector, focusing on coordination and the degree of competition among different actors at different levels in the value chain over time. Data were collected from key value chain actors engaged in provision of input supply and output marketing services in Ada'a milk shed. The major lesson is that the development of coordinated input supply and service delivery by different business entities or under a single business entity may not emerge at once, but through a gradual evolution. This depends on the level of demand for the inputs and services as determined by the degree of demand for milk and milk products, and the economies of scale input suppliers and service providers could attain from the expansion of demands for these inputs and services. Moreover, at the early stage of a hub development, collective actions and integration of services and marketing within a business organisation could be the main strategy to attain efficiency. But, once the demand for inputs and services has grown, competition among different entities will lead to more efficient input supply and service delivery. In general, where there is an increasing demand for inputs and services, there is a faster development of input supply and service provision by private actors and collective actions in a more competitive way. Role of the public sector could change gradually from provision of inputs and services to coordination, capacity building, quality control, and regulation.

Évolution des plateformes d'approvisionnement en intrants et de services dans le développement du secteur de la production laitière dans la laiterie d'Ada'a, en Éthiopie

Pour une fourniture d'intrants et une prestation de services efficaces, il peut se révéler nécessaire de mettre en ?uvre une approche axée sur une plateforme dans le cadre de laquelle tous les intrants et services nécessaires sont fournis de manière coordonnée, soit par un fournisseur unique soit par plusieurs entités séparées, dans un lieu donné accessible aux bénéficiaires. Sur la base de l'expérience de la laiterie d'Ada'a, en Éthiopie, cet article évalue l'évolution de la fourniture d'intrants et de la prestation de services dans le sous-secteur laitier, en se concentrant sur la coordination et sur le degré de concurrence entre différents acteurs et à différents niveaux de la chaîne de valeur au fil du temps. Des données ont été recueillies auprès d'acteurs clés de la chaîne de valeur actifs dans la fourniture d'intrants et dans la prestation de services de commercialisation de la production dans la laiterie d'Ada'a. Le principal enseignement est que le développement d'une fourniture d'intrants et d'une prestation de services coordonnées par différentes entreprises ou dans le cadre d'une entité commerciale unique peut ne pas avoir lieu tout d'un coup, mais au fil d'une évolution progressive. Cela dépend du degré de demande concernant les intrants et les services, tel que déterminé par le degré de demande de lait et produits laitiers, et par les économies d'échelle que les fournisseurs d'intrants et les prestataires de services pourraient obtenir grâce à l'expansion de la demande de ces intrants et services. De plus, au stade initial de la mise en ?uvre d'une plateforme, les actions collectives et l'intégration des services et de la commercialisation dans une organisation commerciale pourraient constituer la principale stratégie pour arriver à l'efficacité. Mais, une fois que la demande en intrants et en services s'est accrue, la concurrence entre différentes entités engendrera une fourniture d'intrants et une prestation de services plus efficaces. En général, lorsqu'il y a une demande croissante d'intrants et de services, il se produit un développement plus rapide de la fourniture d'intrants et de la prestation de services par des acteurs privés dans une optique plus concurrentielle. Le rôle du secteur public pourrait évoluer progressivement, de la fourniture d'intrants et de services à un rôle de coordination, de renforcement des capacités, de contrôle de la qualité et de réglementation.

Evolución de la oferta de insumos y de los centros de servicios en el desarrollo de lácteos en la cuenca lechera de Ada en Etiopía

Para llevar a cabo de manera eficiente la oferta de insumos y la entrega de servicios puede requerirse un centro de servicios cuya ubicación sea accesible a los beneficiarios, a partir del cual los mismos sean suministrados de manera coordinada, ya sea a través de un proveedor único, o bien, a través de varios entes separados. Apoyándose en la experiencia de la cuenca lechera de Ada, localizada en el centro de Etiopía, el presente artículo valora la evolución de la oferta de insumos y de la entrega de servicios en el subsector de lácteos, centrándose en la coordinación y en el grado de competitividad mostrado durante varios años por distintos actores ubicados en diferentes estratos de la cadena de valor. La información fue recopilada de actores clave de la cadena de valor en la cuenca lechera de Ada, quienes proveen insumos y servicios de comercialización de productos. El aprendizaje más importante que ha dejado esta experiencia es que: el desarrollo de la oferta de insumos y de la entrega de servicios – realizadas de manera coordinada por distintas empresas o por una sola – puede no surgir inmediatamente, sino después de una lenta evolución. Ello depende del nivel de demanda de insumos o servicios que, a su vez, depende tanto de la demanda de leche y de productos lácteos como de las economías de escala que pudieran obtener sus proveedores a partir de la expansión de la demanda de estos productos. Asimismo, durante las etapas iniciales del desarrollo de un centro de servicios, las acciones colectivas, la integración de servicios y la comercialización centradas en una sola empresa, podrían constituir la estrategia más importante para mejorar la eficiencia. Sin embargo, una vez que la demanda de insumos y servicios haya crecido, la competencia entre distintas entidades producirá una oferta y una entrega de los mismos más eficiente. En general, en aquellos lugares en que exista una demanda creciente, habrá un desarrollo más rápido de la oferta de insumos y de la entrega de servicios por parte de los actores privados, además de acciones colectivas más competitivas. En consecuencia, el rol del sector público podría modificarse gradualmente, pasando de ser proveedor de insumos y servicios a ser la instancia que coordine, fortalezca capacidades y vigile el control de calidad y las normas.

Evolução dos centros de abastecimento de insumos e serviços no desenvolvimento do setor de laticínio da região produtora de leite de Ada'a, na Etiópia

Uma oferta eficiente de insumos e de serviços pode demandar um centro em que todos os insumos e serviços necessários sejam ofertados de maneira coordenada, seja através de um único fornecedor ou de várias entidades separadas em uma dada área geográfica acessível aos beneficiários. Com base na experiência da região produtora de leite de Ada'a situada na região central da Etiópia, este artigo avalia a evolução da oferta de insumos e de serviços no sub-setor de laticínios, concentrando-se na coordenação e grau de competição entre diferentes agentes em níveis diferentes da cadeia de valores no decorrer do tempo. Os dados foram coletados a partir de agentes-chave da cadeia de valores engajados na oferta de insumos e serviços de marketing na região produtora de leite de Ada'a. A principal lição é que o desenvolvimento da oferta coordenada de insumos e de serviços através de diferentes entidades empresariais ou através de uma única entidade empresarial pode não surgir de uma só vez, mas sim ter uma evolução gradual. Isto depende do nível de demanda dos insumos e serviços, que é determinado pelo grau de demanda de leite e de produtos lácteos, e as economias de escala que os fornecedores de insumos e de serviços podem obter a partir da expansão de demandas por estes insumos e serviços. Além disto, na fase inicial do desenvolvimento de um centro, ações coletivas e integração de serviços e marketing dentro de uma organização empresarial podem ser a estratégia principal para se obter eficiência. Porém, após a demanda por insumos e serviços ter crescido, a competição entre entidades diferentes levará a uma oferta de insumos e de serviço mais eficiente. Em geral, quando há uma demanda crescente por insumos e serviços, há um desenvolvimento mais rápido na oferta de insumos e serviços por agentes privados e ações coletivas mais competitivas. O papel do setor público poderia mudar gradualmente da oferta de insumos e serviços para a coordenação, capacitação, controle de qualidade e regulação.     

If technology is the answer,what does it take?

This article aims to assess why technology such as improved crop varieties has not taken off in Tanzania in spite of substantial efforts, and to consider what role policy plays in that regard. Few farmers use improved varieties due to reasons such as affordability in relation to the low profitability of farming; high risk, including fake seed in the market; and unpredictable policies and marketing opportunities. Effective governance is needed for agriculture to be transformed in the direction stated in national policy documents, but weak institutions and the collective interests of farmers not being sufficiently recognised hinder the likelihood of necessary technological changes happening.     

Food security composite indices: implications for policy and practice

Food security is a major topic in academic and international debates. Numerous indicators have been proposed in order to establish which countries are in need of improved food security status, but the lack of consensus as to which indicator of food insecurity is the most appropriate has motivated scholars to propose composite indexes. Building composite indexes involves multiple choices. This Viewpoint warns how discretional choices of algorithms to compute composite indexes for food security may alter the findings. By commenting on the implications that different measurement choices may have in terms of global indexes, the Viewpoint raises provocative practical and political concerns.     

Measuring the success of HIV/AIDS NGOs among Nairobi's youth

NGOs receive praise and criticism for their international development efforts, but more work is needed to measure their contributions. This article lays out the contributions of local NGOs to HIV-prevention efforts. It draws on data from a survey of young people's experiences with NGOs to demonstrate the reach of several local HIV-prevention NGOs in Nairobi, Kenya. It argues that even small NGOs are capable of making measurable contributions to development in their fields. It also shows how factors such as education levels, religiosity, and discussions about HIV/AIDS can support NGO efforts by encouraging youth to participate in HIV-prevention programming.     

Contextualising emergency responses to famine among Turkana pastoralists in Kenya

The pastoralism of the Turkana has persisted in the challenging environment of northwestern Kenya for some 200 years. Yet many pastoralists find that they increasingly rely on food relief during droughts and famines. This article contextualises emergency responses to famine among Turkana pastoralists by considering their encounters with colonialism, development, and humanitarian interventions. It uses key informant interviews, participant observation, and content analysis, to analyse the benefits and challenges of a small-scale food relief programme. The article argues that such programmes can weaken the viability of pastoralism, and concludes with considerations for future policy and programming.     

Using subsidised seed to catalyse demand-driven bean seed systems in Malawi

Through an innovative public-private partnership, Demeter Agricultural Limited, along with the Malawi National Bean Programme and the International Center for Tropical Agriculture, supplied 2,559 tons of certified bean seed between 2009 and 2012 through the government's Targeted Farm Input Programme. Farmers were satisfied with the variety supplied, timeliness of the operation, pack size, and information provided. Growing numbers also accessed new improved varieties, from 264,661 households in 2009 to 344,200 in 2012. These emerging farmers’ demands and the subsequent DAL responses suggest a base for building sustainable delivery systems. However, decentralised seed-based systems will be needed for promoting varieties suited to micro-ecological niches.     

Indicators for economic vulnerability to drought in South Africa

This article identifies and estimates economic drought vulnerability indicators among communal farmers in South Africa, using an economic vulnerability index based on a household survey of 121 communal farmers. The results show that lack of resources, unemployment, price sensitivity, market access, the level of farm debt, output, on- and off-farm diversification, management, and financial safety nets were the main economic vulnerability variables. Farm debt and financial safety provide the bulk of the vulnerability index. The study’s findings suggest that government should reconsider priorities in the implementation of appropriate policy measures in response to drought.     

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.     

The welfare impacts of market channel choice by smallholder farmers in Tanzania

This article analyses the impact of market channel choice on household welfare by maize and pigeon pea smallholder farmers in Tanzania, using a multinomial endogenous treatment approach. The study utilises farm household-level data collected from a randomly selected sample of 700 smallholder farmers. The results show that participation with traders in nearby markets and wholesalers in nearby towns have a positive effect on consumption expenditure per capita relative to brokers at the farmgate, for both maize and pigeon pea-farming households. The study suggests that interventions that aimed at inclusion of smallholder farmers in more profitable markets could improve household welfare and reduce poverty among rural households.     

Collective action in small-scale mushroom production in Swaziland: does organisational form matter?

While substantial literature is available on the determinants of small-scale farmers’ participation in collective action, and the welfare impacts of producing and/or marketing collectively, studies on the likely implications of organisational form on producers’ collective behaviour remain scant. This article attempts to address this knowledge gap by using an example of different forms of small-scale mushroom-producing groups in Swaziland. Given the importance of collective action in sub-Saharan Africa, the overall results of this article provide valuable insights into alternative means of coordinating commercial small-scale agricultural activities, which can improve producers’ ultimate benefits while reducing the likelihood of internal free-riding.     

The impact of drought on commercial livestock farmers in South Africa

This article reports on a study that aimed to assess the impact of the 2015 drought in South Africa on commercial livestock producers, with specific reference to the associated drought adoption strategies. The study was based on primary data collected from 350 commercial livestock producers from seven different provinces. The findings revealed that the effect of drought had a significant impact on average herd size, livestock feeding, and sheep flock. Commercial livestock producers did not receive any form of assistance from the government. The majority of the farmers did not have any preventive measures in place during the drought. The study recommends that the government and policymakers should introduce a mechanism to support commercial livestock farmers when drought strikes.     

From humanitarian action to development aid in northern Uganda and the formation of a humanitarian-development nexus

The instituted order of humanitarianism is both changing and challenged. This article addresses the transition between humanitarian action and development aid in northern Uganda, which was driven by the government’s ambition to reassert its humanitarian sovereignty by discursively recasting the situation from one of crisis to one of recovery and development, regardless of the persistent humanitarian needs. In response, humanitarian actors either withdrew or moved into development aid. This bourgeoning humanitarian–development nexus questions the nature and future of humanitarianism and whether there is a hierarchy – or contradiction – between the humanitarian mandate and pragmatic approaches to save lives and protect civilians.     

India 2025: the public distribution system and National Food Security Act 2013

The Government of India introduced the National Food Security Act (NFSA) 2013 to strengthen the public distribution system (PDS) in India. Extending the PDS service network is a contentious issue, especially for India’s rural regions. This article aims to estimate the level of expansion of the PDS network, additional food grain requirement, and increased storage facilities required to serve the growing population of India up to 2025. The statistical analysis highlights the need for significant changes in the PDS to meet NFSA, and the findings can aid policy-makers to design a more robust PDS.     

Peacebuilding for faith-based development organisations: informing theory and practice

Faith leaders and their congregations have been recognised as holding the potential to engage positively in peacebuilding activities in a post-conflict context. Alongside this, faith-based development organisations (FBDOs) have the ability to engage with these constituencies to increase the peacebuilding impact of their activities. This paper presents a framework of faith engagement for FBDOs to work with local faith leaders and people of faith to develop the peacebuilding impact of development activities. A reworking of Anderson's “Do No Harm”, it encompasses the areas that FBDOs need to address in order to be effective peacebuilding actors in a faith context.