Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia.

Whilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme. The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance

The expanded public works programme : perspectives of direct beneficiaries

Abstract: Scholarship on the Expanded Public Works Programme (EPWP) in South Africa tends to focus on quantitative evaluation to measure the progress made in the implementation of EPWP projects. The number of employment opportunities created by EPWP, demographic profiling, skills acquired by beneficiaries and training opportunities related to the Programme form the basis of typical statistical evaluations of it, but exclude comment by the workers who participate in its projects. Based on primary sources, including in-depth interviews, newspaper reports and internet sources, this article seeks to provide a qualitative review of the EPWP from the perspective of the beneficiaries of municipal EPWP projects. Various South African government sectors hire EPWP workers to provide local services such as cleaning and maintaining infrastructure, but the employment of these workers can still be regarded as precarious, in the sense that they have no job security, earn low wages and have no benefits such as medical aid or pension fund. The interviewees indicated that, although they appreciate the temporary employment opportunities provided by the EPWP, they also experience health and safety risks and lack the advantages of organised labour groupings. Their main disadvantage, however, is that they cannot access permanent employment, which offers better wages and concomitant benefits

Integrating Human Health into Environmental Impact Assessment: An Unrealized Opportunity for Environmental Health and Justice

The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice

The quality of life of HIV-infected and non-infected women post-caesarean section delivery

There is a dearth of literature on the postnatal quality of life (QoL) of women. This study aimed to determine to QoL of HIV-infected and non-infected women post-caesarean section delivery. This prospective, longitudinal and comparative study was conducted at four public hospitals in KwaZulu-Natal. The participants were followed for six-months post-delivery and the QoL was measured using the SF-36 and the pelvic floor impact questionnaire (PFIQ-7). The results showed that the QoL of women were negatively affected post-operatively with the HIV-infected group scoring lower over the six-months. Understanding postpartum QoL problems is essential in efforts to provide effective comprehensive care.DHE

Competing coalitions: The politics of renewable energy and fossil fuels in Mexico, South Africa and Thailand

This paper analyses why middle-income countries incentivize renewable energy despite inexpensive domestic fossil fuel resources and lack of international support. We examine the politics of renewable energy programs in Mexico, South Africa and Thailand. All three countries hold abundant local fossil fuel and renewable energy resources. We argue that renewable energy programs become implementable policy options in fossil fuel resource-rich middle-income countries when coalitions of powerful political actors support them. This study presents an analysis of the domestic coalitions in support of and those in opposition to renewable energy policies from a discourse network perspective. Discourse networks reflect actors and the arguments they share to advance or hamper the policy process. The analysis draws on a data set of 560 coded statements in support or opposition of renewable energy from media articles, policy documents and interviews. Findings show similar structures of competing coalitions in all three countries, with the discourse in all three countries revealing strong linkages between environmental and economic considerations

Two Types of Planning in Neighborhoods

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68338/2/10.1177_0739456X8400300209.pd

OECD principles on water governance in practice:an assessment of existing frameworks in Europe, Asia-Pacific, Africa and South America

Through the lens of the 12 OECD Principles on Water Governance, this article examines six water resources and water services frameworks in Europe, Asia-Pacific, Africa and South America to understand enhancing and constraining contextual factors. Qualitative and quantitative methods are used to analyze each framework against four criteria: alignment; implementation; on-ground results; and policy impact. Four main target areas are identified for improving water governance: policy coherence; financing; managing trade-offs; and ensuring integrity and transparency by all decision makers and stakeholders. Suggestions are presented to support practical implementation of the principles through better government action and stakeholder involvement.No Full Tex

Digging the backyard : mining and quarrying in the UK and their impact on future land use

The future demand for land for mining and quarrying will be affected by a large number of economic, technological, environmental and social issues within the UK. Global developments also have a role to play. Although mining and quarrying account for only 0.9 per cent of the land area of England, the impact of this activity is considerable. Minerals are essential to the economy, for energy, construction, infrastructure and manufacturing, while their extraction has effects on the environment and on public perception. This paper examines current scientific understanding of the context of mining and quarrying, with particular reference to its impact on land use, along with the spatial relationship between minerals – which can only be worked where they occur – and other forms of land use and designation in the ‘post-industrial’ landscape of Britain. Looking out to 2060 and beyond, developments which may influence demand for minerals include climate change mitigation and adaptation; energy, food and raw material security; and new construction, manufacturing, recycling and re-use technologies. Factors influencing the supply side include the structure and ownership of the mining and quarrying industry, new extraction, processing and environmental technologies, ecosystem service provision, societal attitudes and land access. Although prediction carries a high level of uncertainty, continuous development of the regulatory framework is, and will remain, a major and pervasive factor in the relationship between mining and quarrying and land use

"Before we used to get sick all the time": perceptions of malaria and use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.</p> <p>Methods</p> <p>Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.</p> <p>Results</p> <p>Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.</p> <p>Conclusions</p> <p>Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.</p