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.     

Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the government's health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.     

Farmers,peanuts, and aflatoxins in Uganda: A gendered approach

This article describes a collaborative research for development project that used participatory methods to engage smallholder farmers in Uganda in post-harvest aflatoxin management. It is based primarily on qualitative research with peanut growers tracing ‘the path of the peanut’ through their hand-drawn maps and journal writing. By focusing on everyday life and including recipes and drawings, this research encouraged women's participation and emphasised women's roles. A unique partnership among universities, women's organisations, and farmers created an environment of mutual learning and produced a book documenting food preparation and other post-harvest practices as part of a study and capacity-building effort on peanuts and aflatoxins.     

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.     

“We want financial accountability”: deconstructing tensions of community participation in CHPS,Ghana

This article reports on the ways and factors that facilitate or constrain community participation in the Community-based Health Planning and Services (CHPS) programme in Nsanfo, a village in Central Region of Ghana. We found that the community made an important step through mobilising the necessary resources in establishing the CHPS compound, which has resulted in improved access to health care. Yet maintaining the facility did not matter most to community members, owing chiefly to unmet demands for financial accountability pertaining to the running of the programme. Failure to clearly identify various actors and their roles potentially explains this state of affairs.     

Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda

This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.     

Network development for non-state health providers: African Christian health associations

ABSTRACT

Substantial effort has been put into forming and strengthening national networks of non-state, non-profit health providers in lower- to middle-income contexts. Christian health associations (national umbrella networks of faith-inspired health providers) were first established in the 1950s, and are currently present in an estimated 23 of the 54 countries in Africa. The establishment of CHAs was equally encouraged by faith-based health providers, governments, and external stakeholders. CHAs look different in each context, but perform similar roles: networking diverse institutions and facilities together into a loose system; and establishing a more cohesive sector to simplify and strengthen advocacy and engagement with the government.     

Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

ABSTRACT

In sub-Saharan Africa many individuals rely on non-state health providers, and engagement between state and non-state providers is increasingly common. Little analytic work has been done on the varied models of engagement, resulting in a lack of clarity about the promises and challenges of public–private engagement (PPE) for health. Despite their prevalence, PPEs often fail. Faith-based health providers (FBHPs) form a significant proportion of the non-state health sector in sub-Saharan Africa, and the number of partnerships with FBHPs is increasing. Building on a prior systematic review project that developed a typology of organisational models for PPE for health, this article reports on a secondary analysis, highlighting PPE initiatives with FBHPs.     

WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

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.     

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.     

Reaching beyond the health post: Community-based surveillance for polio eradication

This article discusses the CORE Group Polio Project Ethiopia's introduction of community-based surveillance (CBS) of acute flaccid paralysis (AFP) to support polio eradication. A USAID-funded collaboration among Ethiopian and US-based NGOs, the CGPP supports volunteers in education about AFP and encouraging case reporting. Volunteers also conduct active case searches, visiting community leaders likely to have contact with paralysis cases. The project's methods strengthen communities' awareness of AFP and their connection to the health system. Data indicate a near doubling of AFP reporting in project areas since the implementation of CBS, according to MOH-E (Ministry of Health, Ethiopia)/WHO statistics.

Allant au-delà du poste de santé: surveillance communautaire pour éradication de la poliomyélite

Cet article traite de l'introduction par le Projet sur la polio du CORE Group (CGPP) en Éthiopie de la surveillance communautaire (SC) de la paralysie flasque aiguë (PFA) pour soutenir l’éradication de la polio. Le CGPP, collaboration financée par USAID entre ONG éthiopiennes et basées aux États-Unis, aide des volontaires à mener une éducation sur la PFA et à encourager la notification des cas. Les volontaires effectuent aussi des recherches actives de cas, rendant visite aux leaders communautaires susceptibles d’être en contact avec des cas de paralysie. Les méthodes du projet renforcent la prise de conscience par les communautés de la PFA et leurs liens avec le système de santé. Les données indiquent que le nombre de cas de PFA signalés a presque doublé dans les zones du projet depuis la mise en ?uvre de la SC, d'après les statistiques du Ministère de la Santé, éthiopien et de l'OMS.

Llegar más allá del puesto de salud: vigilancia comunitaria para erradicación de la poliomielitis

Este artículo examina el Proyecto contra la Poliomielitis llevado a cabo en Etiopía por CORE Group (CGPP por sus siglas en inglés), así como el uso que realiza del método de vigilancia comunitaria (VC) para el seguimiento de la parálisis flácida aguda (PFA). El objetivo de este proyecto es erradicar la polio. Constituye un esfuerzo conjunto de ONG etíopes y estadounidenses, financiado por USAID. CGPP apoya la formación de voluntarios para la vigilancia de la PFA, promoviendo la elaboración de informes sobre distintos casos. Asimismo, los voluntarios dan seguimiento a los casos vigentes, realizando visitas a los líderes comunitarios que, con frecuencia, tienen contacto con personas con parálisis. La metodología del proyecto impulsa la conciencia comunitaria en relación a la PFA y al vínculo entre las comunidades y el sistema de salud. Las estadísticas reportadas por el Ministerio de Salud de Etiopía y la OMS indican que, desde que inició la VC, se han duplicado los informes sobre PFA en las áreas abarcadas por el proyecto.

Indo além do posto de saúde: investigação baseada na comunidade para a erradicação da polio

Este artigo discute a introdução da Investigação Baseada na Comunidade sobre casos de paralisia flácida aguda (AFP) do Projeto Pólio do Grupo CORE da Etiópia, voltada para apoiar a erradicação da pólio. Uma colaboração financiada pela USAID entre ONGs baseadas na Etiópia e EUA, o CGPP apóia voluntários na educação sobre AFP e incentiva o relato de casos. Os voluntários também conduzem pesquisas de caso ativas, visitando líderes de comunidade que provavelmente tenham contato com casos de paralisia. Os métodos do projeto fortalecem a conscientização das comunidades a respeito da AFP e sua conexão com o sistema de saúde. Os dados indicam que o número de relatos de AFP nas áreas do projeto quase dobrou desde a Implementação da Investigação Baseada na Comunidade, de acordo com estatísticas da MOH-E/WHO.     

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.     

The role of marginalised women in sanitation initiatives: Somali women in northern Kenya

Research has shown women from marginalised communities have significant articulated needs for sanitation that are often unmet. Using focus group discussions with displaced Somali women living in rural villages in northern Kenya, this study found that women’s central concerns were for personal safety and convenience rather than hygiene; and for alleviation from the pain and discomfort associated with female genital mutilation and reproduction. Based on the findings, the article recommends organisations supporting sanitation initiatives should adopt approaches responsive to women’s particular concerns and needs. It makes specific recommendations for implementing an agenda of participation in a context where women are highly marginalised.     

When development breeds contempt: case examples of community-driven health systems initiatives

This article discusses case examples of community-led initiatives triggered by the introduction of an external development programme in Senegal and Mali. These are community initiatives that learn from projects initiated and funded by an external donor organisation, and transform interventions to better meet their own needs. The circumstances leading to the demand for, and successful establishment of, health infrastructure are examined to understand the triggers. These breakthroughs demonstrate unintended benefits of development, and the need to leverage donor-led initiatives. Therefore, community involvement, participation, and empowerment are key in establishing local ownership in development projects.     

The unfinished village police unit: a contested local development initiative

Community self-help has been the principal strategy for creating social infrastructure in rural Malawi since independence. One rural community in Balaka district, southern Malawi, embarked on a project to construct a police unit as a response to rising incidents of crime. Begun in 1999, the project remains unfinished. There seems to be no interest in completing the work. This paper finds the explanation in the manner the project was initiated and how the village community was involved in its execution.     

Strategic planning through a participatory learning and action framework: a Kenyan study

This paper reflects on the use of a participatory learning and action (PLA) framework in a strategic planning process (SPP) at a primary school in rural Kenya. Successes and challenges are discussed, focusing on the barriers to fully implementing the PLA framework. Additionally, lessons learnt and ways forward for participatory SPPs are outlined. The PLA framework allowed the project stakeholders to engage in a planning process that gave participants a voice in the process. Although PLA methodology faces shortcomings, the application of this model is a step towards making community development more sustainable.     

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.     

Rethinking dependency and development between international and indigenous non-governmental organisations

This article presents a case study detailing how the Netherlands-based international NGO Terre Des Hommes (TDH) works with and impacts the indigenous Tanzanian NGO Umoja wa Maendeleo ya Bukwaya (UMABU) and the Bukwaya region that UMABU serves. The article illustrates how indigenous agency and autonomy are actualised within relationships where indigenous over-reliance and dependency are connected to Western aid organisations. The paper proposes that dependent relationships between Southern and Northern NGO partners can be negotiated by indigenous leaders in order to disseminate resources for development in indigenous communities to a greater extent than previously imagined by Western donor agencies.