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.     

Capacity building at mid-programme: an international education development programme in Malawi

This article reports on a case study of a mid-programme capacity building evaluation within a large education aid programme collaboration between non-governmental educational organisations in Malawi and US university literacy faculty. The article outlines the programme context and its formal and informal capacity building inputs. Analyses of data collected on capacity building at the midpoint of the programme are offered. The authors argue that capacity is built along the life of large programmes, and evaluating capacity building development (and understanding its challenges) before the end of the programme can help cross-national teams of administrators and implementers in modifying programme operations.     

Centring African culture in water,sanitation, and hygiene development praxis in Ghana: a case for endogenous development

International development aid is driven by actors steeped in Western neo-liberal theory and practice. Africa has largely received failed Western aid, administered mainly through international NGOs in neo-comprador relationships. This article calls for African-centred and -led development, revitalised through endogenous development (ED) praxis. Using a water, sanitation, and hygiene (WASH) sector case study from Ghana, the article theorises Africa's WASH development within the context of globalisation and the politics of knowledge production on Africa. It shows how ED provides African people with self-determining and culturally relevant development necessary for WASH justice and improved health and livelihoods.     

Reconciling cultural practices and progress: childbirth in Dove,Ghana

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.     

The persisting challenge of age-for-grade non-compliance in post-free primary education in Kenya

This article examines the prevalence of non-compliance on the age-for-grade policy in the post-free primary education system in Kenya. We utilised data from the 2009 cohort of enrolled primary schoolchildren. The analysis revealed non-compliance to be a persisting concern in the school system, characterised by both under-age and over-age enrolment at the age-for-grade level of analysis in spite of the introduction of free primary education in 2003. Irrespective of the nature of non-compliance, overcrowding in the lower grades is more prevalent, with potential for adverse compromises in quality of learning and the attendant added dimension of the mismatched grade-for-age curricula.     

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.     

Understanding the needs and challenges of a Black community in South Africa

This article reports on a study conducted with an unemployed group of community members residing in the Gugulethu Township in South Africa. The study aimed to gain an in-depth understanding of their needs and challenges, and what they thought could be done to assist and empower them so that they could improve their lives. Their basic human needs were violated during apartheid and as a consequence, they are still battling poverty today. We offer suggestions on how Black communities in South Africa could be supported and empowered in order to become employable and self-reliant.     

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.     

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.     

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.     

Principles for design of projects introducing improved wood-burning cooking stoves

Projects introducing improved stoves that save firewood and reduce emissions and indoor smoke address real needs but have often not succeeded as expected. One of the reasons may be that lessons have not been learnt effectively. We reviewed the only available comprehensive list of principles for stove project design. We modified it, and added more principles based on literature and our own experience. Our list consists of 20 principles covering the areas of awareness creation of multiple benefits, stove design and variety, participation of the beneficiaries, production modes, role of subsidies, and the necessity of accurate assessments and reporting.     

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 Rwandan traditions to strengthen programme and policy implementation

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.     

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.     

Exploring project sustainability: using a multiperspectival,multidimensional approach to frame inquiry

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.     

Donor-induced depoliticisation of development implementation: the case of Ghana’s Compact I

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.     

Sustainable development in cultural projects: mistakes and challenges

This article reports on research that analysed a number of sustainable development reports by international organisations which consolidate findings from different countries, to produce evidence of the powerful role of culture in sustainable development of various communities. The research looked at reports on sustainable development through cultural activities published between 2010 and 2013, which together provide an overview of about 80 sustainable development projects. Drawing on analysis of the development indicators approaches utilised by the reports’ authors, this article identifies the main challenges that cultural practitioners and policymakers face when trying to measure changes achieved through cultural support in developing communities. The paper illuminates various inconsistencies in the employment of qualitative and quantitative indicators of development, confusions between development indicators and cultural activities, and misunderstandings of cultural sustainability. These key mistakes lead to incorrect measurement of development changes. This article provides recommendations for how to address these problems in order to develop a more robust framework for development evaluations.     

Using participatory impact diagrams to evaluate a community development project in Kenya

Participatory approaches for impact assessment are increasingly becoming popular with development organisations for engaging multiple stakeholders. We present our use of participatory impact diagrams as an evaluation tool within a mixed methods impact assessment of several drought-reduction interventions in Kenya. Results show that because men and women have different roles, their experiences of interventions vary. We discuss how this methodology encouraged communities to describe various intervention outcomes including unintended impacts, often overlooked by conventional impact assessment approaches. Methodological challenges included the integration of quantitative data; opportunities for its application within the wider discipline of monitoring and evaluation are considered.

Utilisation des diagrammes d'impact participatives pour évaluer un projet de développement communautaire au Kenya

Les approches participatives de l’évaluation de l'impact sont de plus en plus populaires parmi les organisations de développement pour faire participer des parties prenantes multiples. Nous présentons notre utilisation des diagrammes participatifs des impacts comme un outil d’évaluation dans le cadre d'une évaluation multi-méthodes de l'impact de plusieurs interventions de réduction des inondations au Kenya. Les résultats montrent que, les hommes et les femmes ayant des rôles différents, leurs expériences des interventions varient. Nous discutons de la manière dont cette méthodologie a encouragé les communautés à décrire divers résultats des interventions, y compris les impacts non désirés, souvent oubliés par les approches conventionnelles d’évaluation de l'impact. Parmi les défis méthodologiques figurait l'intégration des données quantitatives ; les occasions de les mettre en application dans le cadre de la discipline du suivi et de l’évaluation sont examinées.

Utilizando diagramas participativos de impacto para evaluar un proyecto de desarrollo comunitario en Kenia

Con el objetivo de involucrar a diversos actores, las organizaciones de desarrollo utilizan cada vez más los enfoques participativos durante la realización de evaluaciones de impacto. En este artículo, las autoras presentan una herramienta de evaluación que utilizaron en el marco de una valoración de impacto: los diagramas de impacto participativo. Éstos incorporan métodos mixtos y fueron aplicados a varias acciones realizadas para reducir los efectos de la sequía en Kenia. Los resultados demuestran que, dado los distintos roles ejercidos por los hombres y las mujeres, sus opiniones en relación a las acciones llevadas a cabo difieren. Las autoras analizan cómo esta metodología promovió que las comunidades describieran los distintos resultados de las intervenciones, incluyendo aquellos impactos no previstos, los cuales a menudo son ignorados por los tradicionales métodos de evaluación de impacto. Entre los retos metodológicos enfrentados destacó la integración de datos cuantitativos. El artículo analiza las oportunidades que existen de aplicar esta metodología en un contexto de monitoreo y evaluación más amplio.

Usando diagramas de impacto participativas para avaliar um projeto de desenvolvimento comunitário em Quênia

As abordagens participativas de avaliação de impacto estão se tornando cada vez mais populares entre as organizações de desenvolvimento em seu objetivo de engajar múltiplos colaboradores. Apresentamos aqui nosso uso de diagramas participativos de impacto como uma ferramenta de avaliação dentro de uma avaliação de impacto com métodos variados sobre várias intervenções para redução da seca no Quênia. Os resultados mostram que pelo fato de homens e mulheres terem diferentes papéis, suas experiências de intervenção variam. Discutimos como essa metodologia incentivou comunidades a descreverem vários resultados de intervenção, inclusive impactos não-intencionais, frequentemente negligenciados por abordagens de avaliação de impacto convencionais. Os desafios metodológicos incluíram a integração de dados quantitativos; são consideradas também as oportunidades para sua aplicação dentro da disciplina mais geral de monitoramento e avaliação.