Experiences, Opportunities and Challenges of Implementing Task Shifting in Underserved Remote Settings: The Case of Kongwa District, Central Tanzania.

Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based

Redefining welfare in Scotland - with or without women?

A significant by-product of the Scottish Independence Referendum debate was the flourishing of proposals across a range of public policy domains. From the Scottish Government’s White Paper to the propositions of Common Weal, the formal parties and their various commissions, and the informal groups in between, taxation, welfare reform, childcare and social care, corporate representation among other policy areas featured in formal policy documents. Using CFA, this paper analyses the extent to which these policy proposals were framed as advancing women’s social, economic and political independence and the extent to which policy and political institutions demonstrated a failure to mainstream gender analysis in public policy formulation despite the political and discursive opportunities offered by structural change

The impact of gender and disability on the economic well-being of disabled women in the United Kingdom:A longitudinal study between 2009 and 2014

The present study examined the economic well-being of disabled and nondisabled men and women in the United Kingdom. Using the 2009–2014 Life Opportunities Survey (N = 6,159 adults), the study is the first longitudinal study to empirically compare the economic well-being of disabled women in contrast to disabled men and nondisabled men and women. Hierarchical linear modelling and hierarchical linear logistic modelling were used to estimate the longitudinal changes. Findings indicate that, overall, disabled women's economic well-being improved significantly between 2009 and 2014 even after controlling for other demographic characteristics. However, the improvements were not substantial enough to significantly narrow the economic disparities between disabled women and disabled men and nondisabled men and women. Disabled women remained worse off than disabled men and nondisabled men and women in 2014 as they did in 2009. The findings indicate that intersectional discrimination against disabled women exist in the United Kingdom. Findings from this study provide empirical evidence to support policies that enhance the economic security of disabled women.</p

"I am nothing": experiences of loss among women suffering from severe birth injuries in Tanzania

\ud Despite the increased attention on maternal mortality during recent decades, which has resulted in maternal health being defined as a Millennium Development Goal (MDG), the disability and suffering from obstetric fistula remains a neglected issue in global health. Continuous leaking of urine and the physical, emotional and social suffering associated with it, has a profound impact on women's quality of life. This study seeks to explore the physical, cultural and psychological dimensions of living with obstetric fistula, and demonstrate how these experiences shape the identities of women affected by the condition. A cross-sectional study with qualitative and quantitative components was used to explore the experiences of Tanzanian women living with obstetric fistula and those of their husbands. The study was conducted at the Comprehensive Community Based Rehabilitation Tanzania hospital in Dar es Salaam, Bugando Medical Centre in Mwanza, and Mpwapwa district, in Dodoma region. Conveniently selected samples of 16 women were interviewed, and 151 additional women responded to a questionnaire. In addition, 12 women affected by obstetric fistula and six husbands of these affected women participated in a focus group discussions. Data were analysed using content data analysis framework and statistical package for the social sciences (SPSS) version 15 for Microsoft windows. The study revealed a deep sense of loss. Loss of body control, loss of the social roles as women and wives, loss of integration in social life, and loss of dignity and self-worth were located at the core of these experiences. The women living with obstetric fistula experience a deep sense of loss that had negative impact on their identity and quality of life. Acknowledging affected women's real-life experiences is important in order to understand the occurrence and management of obstetric fistula, as well as prospects after treatment. This knowledge will help to improve women's sense of self-worth and maintain their identity as women, wives, friends and community members. Educational programmes to empower women socially and economically and counselling of families of women living with obstetric fistula may help these women receive medical and social support that is necessary.\u

Dimensions of patient satisfaction with comprehensive abortion care in Addis Ababa, Ethiopia

BACKGROUND: Patient satisfaction is a measure of the extent to which a patient is content with the health care received from health care providers. It has been recognized as one of the most vital indicators of quality. Hence, it has been studied and measured extensively as part of service quality and as a standalone construct. In spite of this, there has been limited or no studies in Ethiopia that describe factors of abortion care contributed to women’s satisfaction. This study aimed to identifying the underlying factors that contribute to patient satisfaction with comprehensive abortion care and at exploring relationships between total satisfaction scores and socio-demographic and care-related variables in Addis Ababa, Ethiopia. METHODS: At the beginning of the study in-depth interviews with 16 participants and a focus group discussion of 8 participants were conducted consecutively at the time of discharge to generate questions used to evaluate women’s satisfaction with abortion care. Following generation of the perceived indicators, expert review, pilot study, and item analysis were performed in order to produce the reduced and better 26 items used to measure abortion care satisfaction. A total sample size of 450 participants from eight health facilities completed the survey. Principal component exploratory factor analysis and confirmatory factor analysis were conducted respectively to identify and confirm the factors of abortion care contributing to women’s satisfaction. Mean satisfaction scores were compared across socio demographic and care-related variables such as age, educational level, gestational age (first trimester and second trimester), and facility type using analysis of variance. RESULTS: Exploratory factor analysis of the 26 items indicated that satisfaction with abortion care consisted of five main components accounting for 60.48% of the variance in total satisfaction scores. Factor loadings of all items were found to be greater than 0.4. These factors are named as follows: “art of care” which means interpersonal relationships with the care-provider, “physical environment” which means the perceived quality of physical surroundings in which care is delivered, including cleanliness of facilities and equipment, “information” which means the information received related to abortion procedures, “privacy and confidentiality”, “quality of care” which refers to technical quality of the care provider. Furthermore, analysis of variance showed that overall satisfaction is found to be related to facility type, relationship status, gestational age, and procedural type. CONCLUSION: The findings provided support that women’s satisfaction with comprehensive abortion care has five major factors. Therefore, to improve the overall quality of comprehensive abortion care, attention should be given to the advancement of these components namely, positive interpersonal communication with care-receiver, pleasantness of physical environment, offering enough information related to the procedure, securing clients’ privacy during counseling and treatment, and technical quality of the providers

A strategic assessment of cervical cancer prevention and treatment services in 3 districts of Uttar Pradesh, India

BACKGROUND: Despite being a preventable disease, cervical cancer claims the lives of almost half a million women worldwide each year. India bears one-fifth of the global burden of the disease, with approximately 130,000 new cases a year. In an effort to assess the need and potential for improving the quality of cervical cancer prevention and treatment services in Uttar Pradesh, a strategic assessment was conducted in three of the state's districts: Agra, Lucknow, and Saharanpur. METHODS: Using an adaptation of stage one of the World Health Organization's Strategic Approach to Improving Reproductive Health Policies and Programmes, an assessment of the quality of cervical cancer services was carried out by a multidisciplinary team of stakeholders. The assessment included a review of the available literature, observations of services, collection of hospital statistics and the conduct of qualitative research (in-depth interviews and focus group discussions) to assess the perspectives of women, providers, policy makers and community members. RESULTS: There were gaps in provider knowledge and practices, potentially attributable to limited provider training and professional development opportunities. In the absence of a state policy on cervical cancer, screening of asymptomatic women was practically absent, except in the military sector. Cytology-based cancer screening tests (i.e. pap smears) were often used to help diagnose women with symptoms of reproductive tract infections but not routinely screen asymptomatic women. Access to appropriate treatment of precancerous lesions was limited and often inappropriately managed by hysterectomy in many urban centers. Cancer treatment facilities were well equipped but mostly inaccessible for women in need. Finally, policy makers, community members and clients were mostly unaware about cervical cancer and its preventable nature, although with information, expressed a strong interest in having services available to women in their communities. CONCLUSION: To address gaps in services and unmet needs, state policies and integrated interventions have the potential to improve the quality of services for prevention of cervical cancer in Uttar Pradesh

Political discourse and gendered welfare reform: a case study of the UK coalition government

In the UK, as in many other countries, welfare reform in the aftermath of the 2008 financial crisis has had a detrimental effect on gender equality. Between 2010 and 2015 the UK Coalition government initiated far-reaching cuts to public spending, as well as an increase in welfare conditionality. These reforms have hit women harder than men as they are more likely to rely on welfare benefits and services due to unpaid care responsibilities. Many have suggested that the way in which issues are represented by policymakers can limit what can be conceived as appropriate policy solutions. In line with this, Bacchi’s What’s the problem represented to be? (WPR) approach is used in this article to interrogate the way in which welfare was problematised by the UK Coalition government. Findings suggest that the Coalition’s represented reform as necessary to make work pay, with ‘work’ promoted as paid work and unpaid care work (predominantly undertaken by women) ignored. It also highlights the ways in which the Coalition’s promotion of paid work silenced the necessity and value of care, allowing for the implementation of welfare reforms which have disproportionately disadvantaged women and exacerbated gender inequality

Redraft of The Equality Act 2010 (Specific Duties) (Scotland) Regulations 2022

No abstract available

Our Bodies, Our Rights: Research Report

Disabled women’s lives and lived experiences have received limited policy attention in the UK, limited visibility, and limited inclusion in mainstream feminisms and feminist projects. Despite increasing movement towards intersectionality and intersectional agendas, disabled people have remained hidden in myriad ways. As the accompanying policy report ‘Our Bodies, Our Rights: Identifying and removing barriers to disabled women’s reproductive rights in Scotland’ details, there is a lack of robust research examining the lived experiences of reproduction and reproductive rights of disabled women in Scotland. Women with Learning Disabilities’ reproductive rights have been recognised and pointed to in the Scottish Government’s Keys to Life1 strategy in implicit ways. The 52 recommendations encapsulate a need to ensure the wellbeing, health and equal citizenship of people with learning disabilities in Scotland, which includes their rights to family life, support, inclusion and reproductive health. Similarly, the ‘A Fairer Scotland For Disabled People’2 delivery plan also points to improving the lives of disabled people in Scotland and specifically references the ‘Equally Safe’3 strategy in recognising the need to support disabled women and girls who are subject to gender based violence. This delivery plan and the Keys to Life recognise the need to meet international obligations to disabled people under the United Nations Conventions for the Rights of Persons with Disabilities4 (2006/2008) signed by the United Kingdom in 2009. The UNCRPD explicitly recognises the rights of disabled women throughout. Article 3, the general principles of the convention emphasise respect, dignity, autonomy, participation and independence and explicitly references the equality of men and women. The convention recognises that disabled girls and women are disproportionally at risk of violence (in all its forms) and exploitation. Article 6 of the convention is dedicated to disabled women and lays out states’ obligations to fulfil the rights of disabled women, to take all measures to ensure the advancement of disabled women’s rights and ‘fundamental freedoms’. Articles 7 and 8 outline the rights of disabled children and states’ obligation to provide equal education to disabled people and to ‘promote awareness of the capabilities and contributions of persons with disabilities’. Articles 10, 12, and 13 articulate the right to life and dignity, to equality under the law and access to justice and crucially articles 22 and 23 outline respect for privacy and respect for home and family life. Articles 22 and 23 emphasise the rights of disabled people to not be subject to ‘arbitrary interference’ by the state and to ‘eliminate discrimination against persons with disabilities in all matters relating to marriage, family, parenthood 1 The Keys to Life: Scotland’s Learning Disability Strategy www.keystolife.info/ 2 A Fairer Scotland www.gov.scot/publications/fairer-scotland-disabled-people-delivery-plan-2021-united- nations-convention/ 3 Equally Safe: National Strategy www.gov.scot/publications/equally-safe/ 4 United Nations Convention on the Rights of Persons with Disabilities http://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html 2 and relationships...’ as such disabled women have the right to found families and to have access to meaningful and equal information on sexual and reproductive health, parenting and family planning. It recognises the right of disabled women and to ‘retain their fertility on an equal basis with others’ and that disabled parents are able to parent their children. While this is a brief indication of the rights and freedoms laid out in the UNCRPD they undoubtedly speak to the gendered nature of human rights. Similarly, the United Kingdom Equality Act5 (2010) protects and articulates the rights of disabled people to be treated equally, to not be subject to discrimination or unequal treatment. There is further recognition of a risk of discrimination outlined by the protected characteristic (PC), pregnancy and maternity, and potential for intersection with PCs sex, sexual orientation and gender reassignment. However, academic research and grey literature has identified that disabled women face ongoing inequality and discrimination, and that though significant intersectional disadvantage exists in the space between PCs, the legislation is unable to challenge this. Scotland’s disability policy reflects and has aimed to challenge the wider social invisibility of the gendered realities of disability including the reproductive equality, experiences and health of disabled women in Scotland. Engender Scotland, the Scottish Learning Disabilities Observatory and the University of Glasgow have responded to this epistemic gap through the ‘Our Bodies, Our Rights’ project and aim to make the unequal lives of disabled women more visible in social and health data

Gender audit 2000 Putting Scottish women in the picture

Co-published with Governance of Scotland ForumSIGLEAvailable from British Library Document Supply Centre-DSC:m02/33308 / BLDSC - British Library Document Supply CentreGBUnited Kingdo