HIV/AIDS and time allocation in rural Malawi

AIDS morbidity and mortality are expected to have a large impact on households’ labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women’s time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor).Africa, AIDS/HIV, economic impact, Malawi, time allocation

Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa

CITATION: Van De Ruit, C., Lahri, S. & Wallis, L. A. 2020. Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa. African Journal of Emergency Medicine, 10(2):52-57, doi:10.1016/j.afjem.2019.12.004.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction: Crowding is a significant challenge for emergency centres (ECs) globally. While South Africa is not alone in reckoning with high patient demand and insufficient resources to treat these patients; staff-to-patient ratios are generally lower than in the Global North. The study of crowding and its consequences for patient care is a key research priority for strengthening the quality and efficacy of emergency care in South Africa. The study set out to understand frontline staff's perspectives on crowding in Cape Town public ECs to learn how they cope in such high- pressure working conditions, determine what they see as the factors contributing to crowding, and obtain their recommendations for reform. Methods: This research is a qualitative study from interviews and observations at five ECs in Cape Town, con- ducted in June and July 2017. In total 43 staff were interviewed individually or in pairs. The interviews included physicians of varying levels of experience (25), and registered or enrolled nurses (18). Data were analysed with the qualitative text-analysis software NVivo. Results: Both doctors and nurses saw crowding as a consequence of three factors: 1) limited bed space in the EC, 2) insufficient health professionals to care for admitted patients, and 3) the presence of boarders. Systemic or organizational factors as well as human resource scarcity were determined to be the key reasons for crowding. Discussion: With its high patient acuity and volume and its limited human and material resources, South Africa is an important case study for understanding how emergency care providers manage working in crowded condi- tions. The solutions to crowding recomme the EC workforce and to add discharge lounges and examination tables.https://www.sciencedirect.com/science/article/pii/S2211419X19301648?via%3DihubPublisher’s versio

An analysis of emerging relationships in water provision: an analysis of emerging relationships in water provision in South Africa.

Thesis (M.A.)-University of Natal, Durban, 1999.South Africa has one of the highest levels of inequality in the world, and the government has attempted to redress extensive material, social and political deprivation. It has been confronted by the tension between the need for rapid delivery of essential services and the aspiration for people-centred development. Limited resources and insufficient capacity have led the state to contract out service provision to the private sector. There has also been a shift toward self-sufficiency which has placed pressure on service users to manage their own development. 'Public-private Partnerships' have come to be a common feature of many development projects. These partnerships must be understood in relation to prevailing conditions within South Africa. Extensive poverty, social turbulence, an unaccountable state bureaucracy particularly in local government, and vested interests which do not support the goals of redistribution envisaged in the constitution all exist. Public-private partnerships are relatively new to South Africa. Four issues were raised about these relationships: Will they lead to the promotion of efficient and effective service delivery? Do they promote good governance? Is there a specific role for NGOs in public-private partnerships and finally what are the conditions for genuine participation by local communities within public-private partnerships? A study of public-private partnerships in the water sector, involved in the Community Water Supply and Sanitation Programme was undertaken. A variety of research methods, notably formal and semi-formal interviews and focus group discussions were employed to explore these relationships. Fieldwork was conducted between November 1998 and January 1999. The research involved familiarisation with new South African policy legislation which is set to alter the entire institutional environment. The study also drew upon international literature in order to assess the influence of global changes upon the water sector in South Africa, and also to locate the forms of water service provision within broader theoretical contexts. The key organisations which were investigated, and those which played a role in the Community Water Supply and Sanitation Programme were: the Department of Water Affairs and Forestry; the Mvula Trust, a large national non government organisation (NGO); various water committees supported by the Mvula Trust; and the Build, Operate, Train and Transfer (BOTT) consortia, which are joint ventures between the Department of Water Affairs and Forestry (DWAF), private firms and the Mvula Trust. Turning first to the question of the efficiency and effectiveness of public-private partnerships in service delivery, the findings of this study reveal that there are gaps in service delivery in the water sector which are not being filled by public-private partnerships. Poor performance by project managers, cases of exploitation by project and training agents of community organisations, and insufficient accountability (especially on the BOTT projects) towards the water users, are widely in evidence. Key leadership and managerial functions within these ventures are missing. The findings of the study reinforce the need for the state to play an active role in managing and leading public-private partnerships. The second issue concerning the relationship between public-private partnerships and good governance, reflects confusion in state priorities. The Water Services Act stipulates the importance of local government managing water service provision. Yet public-private partnerships currently bypass this level of governance. Turning to the third issue of the role for NGOs in public-private partnerships, it could be argued that like other NGOs in South Africa Mvula has to deal with various contradictions. In many ways it operates as a parastatal, not as an NGO. Mvula is dependent on the state for funding, the recent funding crisis has highlighted the dangers of such reliance upon the state, and Mvula can be criticised for being short sighted and too trusting. It has also meant that Mvula has had to adopt DWAF's policy objectives which differ markedly from those of the Trust. At another level, though, Mvula's ability to introduce innovative approaches to water service delivery and to influence policy on water service delivery proves that there are ways in which state and non-state actors can engage in useful relationships. The debate about participation has also been woven into the discussion about public-private partnerships. The basis for public-private partnerships in South Africa has been that local communities would manage their own development processes. Radical participation has been entrenched both in the constitution of SA and in the goals of the RDP. Yet none of the actors (even the Mvula Trust) promote radical participation. At best a watered down version based on community consultation was applied, although in numerous projects participation was token. For the foreseeable future participation will remain a central element of service delivery. Service providers will have to allocate more resources and time toward supporting community organisations to manage their own development. This in tum will increase the costs of service delivery. In the long term these functions should be handed over to local government, in order that rural dwellers may concentrate on their livelihoods. The most critical project in the next ten to fifteen years will be to build strong local government. The biggest challenge will be to change the organisational mindset of these presently conservative and weak structures. A theme, which has underpinned this dissertation, has been the debate between efficiency and equity. Questions remain as to whether it was possible to reconcile these perhaps conflicting goals. In essence: was it possible for public-private partnerships to deliver basic services, both speedily and by redistributing resources to the poorest. This research has found that public-private partnerships in the water sector have failed to excel with either of these goals. The Mvula trust is concerned with the participation of the poorest, yet these projects are much slower than the services provided by the BOTT consortia. The BOTT consortia are able to undertake rapid service delivery although there is limited involvement by local communities, which in turn threatens the long-term sustainability of the BOTT projects. The lessons to be learnt from this case study are that privatisation and the contracting out of state services need to be accompanied by the simultaneous development of strong institutions. These include NGOs, CBOs, private contractors and local and national state institutions

The institutionalization of AIDS orphan policy in South Africa

This dissertation examines the organization of primary health care for children in South Africa. The study is founded on a central research question: how has the injection of global humanitarian funding directed toward mitigating AIDS reshaped the organization of care for children in South Africa? Social science scholarship on global AIDS policy has largely focused on patients or service recipients; limited work, however, has been directed at the interface between care-workers and service recipients. In focusing on care-worker and service recipient interactions in local settings in South Africa, this dissertation contributes to scholarship concerned with the quality of care provision in the midst of widespread suffering as a result of the AIDS epidemic. The investigation is based on a twenty-one-month ethnographic field study, from August 2007 to June 2009, undertaken in the province of KwaZulu-Natal, South Africa. Data collection methods included interviews with policymakers and policy implementers; participant-observation in English and Zulu of local groups engaged in orphan projects; document analysis of policy texts; and historical archival research. The results of the study are threefold: First, document analysis on orphan policy reveals how in South Africa it is based on a standardized package of interventions imported from global policy. This standard package adopts market-based forms of governance that transfer the responsibility for orphan health and welfare service delivery from the state to the community or the family. A second finding, derived from ethnographic observations, is that humanitarian policy designed to improve the life conditions of South African children is undermined by initiatives to ensure program efficiency through the reliance on unpaid community care-workers, which leads to conflict, competition, and the reproduction of racial inequality in care-work organizations. Third and finally, participant-observation in a rural village and an urban township reveal how orphan became a productive category for an array of groups involved in the implementation of AIDS orphan policy. However, the dissertation argues that orphan policy produces new forms of social exclusion amongst families, devastated by apartheid and AIDS, who do not qualify for orphan health and welfare support

Knowledge, Perceptions, and Social Influences of Smokeless Tobacco Use in Collegiate Male Athletes

In the United States today, tobacco is the leading cause of preventable deaths and diseases. Tobacco comes in many forms and can be smoked, chewed, or sniffed. It not only contains nicotine which is highly addictive, it also contains a number of other carcinogens, especially tobacco specific nitrosamines. Smokeless tobacco, which can be in the form of loose leaves, plugs (bricks), pouches, or twists of rope, is either chewed or held in place, allowing the nicotine to be absorbed through the lining of the mouth. Smokeless tobacco is known to lead to negative health effects such as oral, throat, and other cancers, mouth sores, gum and tooth decay, high blood pressure, heart attack, and even stroke. Young adult males ages 18-24 are the most common users of smokeless tobacco and at an increased risk of developing other poor health habits due to new stressors and social relationships that come along with this transitional period in life. Research suggests that male college athletes are an even higher risk for smokeless tobacco use due to the added pressure of performing well in their sport as well as in school and society. A survey examining the prevalence of smokeless tobacco use, knowledge, perceived risk, and social influences of smokeless tobacco was given to male lacrosse, baseball, and track and field athletes (N=51) at Ursinus College. Results showed that there was a significant difference in the levels of knowledge of smokeless tobacco health risks between users and nonusers, but not a significant difference in perceived risk or social influences between users and nonusers. Further research should be done on this topic using a larger population and a variety of different colleges or universities and sports

HIV/AIDS and time allocation in rural Malawi

AIDS morbidity and mortality are expected to have a large impact on households' labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women's time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor)