Exploring politics and contestation in the policy process: The case of Zambia’s contested community health strategy

There have been increased calls for low- and middle-income countries to develop community health systems (CHS) policies or strategies. However, emerging global guidance brackets the inherent complexity and contestation of policy development at the country level. This is explored through the case of Zambia’s 5-year Community Health Strategy (CH Strategy), formulated in 2017 and then summarily withdrawn and reissued two years later, with largely similar content. This paper examines the events, actors, and contexts behind this abrupt change in the Strategy, through an analysis of documentary sources and interviews with 21 stakeholders involved in the policy process. We describe an environment of contestation, characterised by numerous international partners weighing in on the CH Strategy, interfacing with shifting loci of responsibility for the CHS in the Ministry of Health (MoH). Despite the rhetoric of participation, providers and communities played no part in the policy process. These dynamics created the conditions for the abrupt change in strategy, illustrating the inherently fraught and political nature of policy development on the CHS in many countries. Going forward, we conclude that paying attention to processes of CHS policy development, and in particular the interaction between events, actors, and contexts, is as important as ensuring meaningful policy content

Drinking water quality from rural handpump-boreholes in Africa

Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0–626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 μg l−1 (range 400 μg l−1) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination

Monitoring changes in the cultivation of pigeonpea and groundnut in Malawi using time series satellite imagery for sustainable food systems

Malawi, in south-eastern Africa, is one of the poorest countries in the world. Food security in the country hinges on rainfed systems in which maize and sorghum are staple cereals and groundnut and pigeonpea are now major grain legume crops. While the country has experienced a considerable reduction in forest lands, population growth and demand for food production have seen an increase in the area dedicated to agricultural crops. From 2010, pigeonpea developed into a major export crop, and is commonly intercropped with cereals or grown in double-up legume systems. Information on the spatial extent of these crops is useful for estimating food supply, understanding export potential, and planning policy changes as examples of various applications. Remote sensing analysis offers a number of efficient approaches to deliver spatial, reproducible data on land use and land cover (LULC) and changes therein. Moderate Resolution Imaging Spectroradiometer (MODIS) products (fortnightly and monthly) and derived phenological parameters assist in mapping cropland areas during the agricultural season, with explicit focus on redistributed farmland. Owing to its low revisit time and the availability of long-term period data, MODIS offers several advantages, e.g., the possibility of obtaining cloud-free Normalized Difference Vegetation Index (NDVI) profile and an analysis using one methodology applied to one sensor at regular acquisition dates, avoiding incomparable results. To assess the expansion of areas used in the production of pigeonpea and groundnut resulting from the release of new varieties, the spatial distribution of cropland areas was mapped using MODIS NDVI 16-day time-series products (MOD13Q1) at a spatial resolution of 250 m for the years 2010–2011 and 2016–2017. The resultant cropland extent map was validated using intensive ground survey data. Pigeonpea is mostly grown in the southern dry districts of Mulanje, Phalombe, Chiradzulu, Blantyre and Mwanza and parts of Balaka and Chikwawa as a groundnut-pigeonpea intercrop, and sorghum-pigeonpea intercrop in Mzimba district. By 2016, groundnut extent had increased in Mwanza, Mulanje, and Phalombe and fallen in Mzimba. The result indicates that the area planted with pigeonpea had increased by 29% (75,000 ha) from 2010–2011 to 2016–2017. Pigeonpea expansion in recent years has resulted from major export opportunities to Asian countries like India, and its consumption by Asian expatriates all over the world. This study provides useful information for policy changes and the prioritization of resources allocated to sustainable food production and to support smallholder farmer

Monitoring Changes in the Cultivation of Pigeonpea and Groundnut in Malawi Using Time Series Satellite Imagery for Sustainable Food Systems

Malawi, in south-eastern Africa, is one of the poorest countries in the world. Food security in the country hinges on rainfed systems in which maize and sorghum are staple cereals and groundnut and pigeonpea are now major grain legume crops. While the country has experienced a considerable reduction in forest lands, population growth and demand for food production have seen an increase in the area dedicated to agricultural crops. From 2010, pigeonpea developed into a major export crop, and is commonly intercropped with cereals or grown in double-up legume systems. Information on the spatial extent of these crops is useful for estimating food supply, understanding export potential, and planning policy changes as examples of various applications. Remote sensing analysis offers a number of efficient approaches to deliver spatial, reproducible data on land use and land cover (LULC) and changes therein. Moderate Resolution Imaging Spectroradiometer (MODIS) products (fortnightly and monthly) and derived phenological parameters assist in mapping cropland areas during the agricultural season, with explicit focus on redistributed farmland. Owing to its low revisit time and the availability of long-term period data, MODIS offers several advantages, e.g., the possibility of obtaining cloud-free Normalized Difference Vegetation Index (NDVI) profile and an analysis using one methodology applied to one sensor at regular acquisition dates, avoiding incomparable results. To assess the expansion of areas used in the production of pigeonpea and groundnut resulting from the release of new varieties, the spatial distribution of cropland areas was mapped using MODIS NDVI 16-day time-series products (MOD13Q1) at a spatial resolution of 250 m for the years 2010–2011 and 2016–2017. The resultant cropland extent map was validated using intensive ground survey data. Pigeonpea is mostly grown in the southern dry districts of Mulanje, Phalombe, Chiradzulu, Blantyre and Mwanza and parts of Balaka and Chikwawa as a groundnut-pigeonpea intercrop, and sorghum-pigeonpea intercrop in Mzimba district. By 2016, groundnut extent had increased in Mwanza, Mulanje, and Phalombe and fallen in Mzimba. The result indicates that the area planted with pigeonpea had increased by 29% (75,000 ha) from 2010–2011 to 2016–2017. Pigeonpea expansion in recent years has resulted from major export opportunities to Asian countries like India, and its consumption by Asian expatriates all over the world. This study provides useful information for policy changes and the prioritization of resources allocated to sustainable food production and to support smallholder farmers

Assessing the Impact of Vocabulary Similarity on Multilingual Information Retrieval for Bantu Languages

Despite the availability of massive open information and efforts to promote multilingualism on the Web, content in Bantu languages remains negligible. Additionally, Information Retrieval (IR) systems, such as the Google search engine, use algorithms that work well with languages that have the most content. Similarities across related languages such as vocabulary overlap can potentially be exploited to provide more opportunities for information access for languages with limited digital content. This study investigates how vocabulary similarity impacts on the quality of search results in Multilingual Information Retrieval (MLIR) environments. More specifically, the study evaluates indexing strategies for MLIR and their effect on the quality of retrieval for related languages. A multilingual test collection consisting of two Bantu languages, Citumbuka and Chichewa, and English was developed and used in the evaluation. The results show that when comparing related and unrelated language pairs, MLIR indexing strategies result in comparable or worse retrieval performance

Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

The Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study randomized HIV-infected mothers and their infants to receive either maternal lipid-based nutrient supplements (LNS) during lactation or no LNS and then to 1 of 3 antiretroviral drug (ARV) arms (maternal, infant, or no drugs). Assigned interventions were provided from 0 to 28 wk and all infants (n = 1619) were given LNS during (24–28 wk) and following (28–48 wk) weaning. This paper assesses the feasibility of infant LNS as a breastmilk replacement and uses longitudinal random effects models to examine associations of interventions, morbidity, and season with weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BMIZ) Z-scores from 24 to 48 wk. Infant LNS adherence was high (94.1% ate it daily). From 24 to 48 wk, mean WAZ (−0.42 to −0.76 SD; P 0 throughout. A higher LAZ was associated with assignment to the maternal LNS arm (β=0.19; P < 0.05). Lower WAZ and BMIZ were associated with seasonal food insecurity (β=−0.08 and −0.09, respectively; both P < 0.001), fever (β=−0.07 and −0.13; both P < 0.001), diarrhea (β=−0.19 and −0.23; both P < 0.001), and assignment to the infant ARV arm (β=−0.17 and −0.17; both P < 0.05). The magnitude of the season and morbidity effects was small and BAN infants had higher weights and lengths than their counterparts in the general population. High LNS adherence and the modest impact of morbidity on growth indicate that LNS is a feasible breastmilk replacement for HIV-exposed infants weaned early, but controlled trials are needed to quantify the effects of LNS on growth in this population

UPGro Hidden Crisis Research Consortium : project approach for defining and assessing rural water supply functionality and levels of performance

This technical brief is aimed at sharing the learning and approaches developed by the UPGro Hidden Crisis Research Project to look at how the functionality and performance levels of boreholes equipped with handpumps (HPBs), can be assessed using a common set of definitions and methods. A tiered approach to defining and measuring functionality is found to be useful to examining functionality for different scales and purposes of monitoring. This report is aimed at national and regional actors involved in the provision and monitoring of rural water supply functionality. The brief sets out the tiered functionality definitions, and accompanying survey methods, which were developed by the project and have been applied in functionality surveys across Ethiopia, Uganda and Malawi [5-7]. The brief provides a summary of: • The tiered approach to defining and measuring the functionality and performance levels of boreholes equipped with handpumps (HPBs). • A series of survey methods which were found to be useful by the Hidden Crisis project to collect sufficient data to assess HPB functionality across the tiered definition approach. • A series of guidelines which could form core criteria for assessing functionality and performance levels of water points . This summary should be read in conjunction with the appendices which provide details of the methods and approaches described

The Role of Mobile Phones in Governance-Driven Technology Exports in Sub-Saharan Africa

This study assesses how the mobile phone influences governance to improve information and communication technology (ICT) exports in Sub-Saharan Africa with data from 2000-2012. The empirical evidence is based on Generalised Method of Moments and three main governance concepts are used, namely: (i) institutional (comprising the rule of law and corruption-control); (ii) political (involving political stability/no violence and voice & accountability) and (iii) economic (including regulation quality and government effectiveness) governance. The following findings are established. First, there are positive net effects on ICT goods exports from independent interactions between mobile phones and ‘political stability’ ‘voice and accountability’ and corruption-control. Second, significant net effects are not apparent from independent interactions between mobile phones and government effectiveness, regulation quality and the rule of law. Theoretical and practical implications are discussed