Homelessness and housing stress among police detainees: results from the DUMA program

This research reaffirms the need for intensive accommodation support services to complement criminal justice responses to crime and those who have contact with the criminal justice system. Foreword It is generally accepted that a person’s living situation, in particular their experience of homelessness and housing stress, can have both long-lasting and wide-ranging consequences. For criminal justice practitioners, the task of limiting homelessness and preventing crime remain key policy priorities in need of ongoing and integrated research. This paper provides a much needed examination of homelessness and housing stress among Australia’s criminal justice population. Using data from the AIC’s Drug Use Monitoring in Australia program, this study examines the prevalence and nature of homelessness among a sample of police detainees. It is the first of its kind to examine a broader range of homelessness experiences and the reasons why some offenders have few choices but to ‘sleep rough’ or seek accommodation support. Importantly, the authors estimate that 22 percent of the detainee population is homeless or experiencing housing stress in some form; much higher than has been previously estimated. This research reaffirms the need for intensive accommodation support services to complement criminal justice responses to crime and those who have contact with the criminal justice system

Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale

This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where ‘country ownership’ of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting ‘embedded’ research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change

Sexual and Reproductive Health Rights of Women Living with HIV in South Africa

South Africa‟s constitutional and legal framework reflects the country‟s commitment to women‟s Sexual and Reproductive Health and Rights (SRHR), in line with international commitments. Numerous policies detail the provision of services around sexual and gender-based violence, fertility, maternal, perinatal and newborn health, sexually transmitted infections (including HIV), and cancers of the reproductive system. However, these policies exist in a social climate of extreme inequality, with high rates of poverty and unemployment. Despite almost equal representation of women in government and other high-profile areas, women in South Africa experience unprecedented rates of sexual and gender-based violence, and women‟s autonomy is all too often compromised by poverty, limited access to education, limited access to health care, and ongoing gender inequality that is bolstered by patriarchal norms.DFI

Responding to the Threat of Nutrition-related Non-communicable Disease

Shifts in society, demography, technology and the environment are significantly impacting the global burden of disease, with non-communicable disease (NCD) on the rise. Almost half of all deaths attributable to NCD have nutrition as the predominant risk factor (cardiovascular diseases and diabetes). This briefing provides an overview of policy options that have been or could be adopted across a number of sectors, specifically health systems, social protection, food, agriculture and nutrition, and governance. It recommends that the international development community pay greater attention to the undermining effect of NCD, and develop cross-sectoral policy responses to respond to this growing threat.UK Department for International Developmen

Equity and Inclusion in Health Programming

Equity and inclusion are key issues for the Swiss Agency for Development and Cooperation (SDC), given its strong commitment to the Agenda 2030 principle of “leaving no one behind” and to achieving Universal Health Coverage. However, efforts to guarantee equity and inclusion face not only technical and material challenges but also social and political ones, especially in relation to governance and accountability

The Health of Women and Girls in Urban Areas with a Focus on Kenya and South Africa: A Review

This thematic review focuses on a range of health challenges faced in particular by women and girls living in low-income urban settlements in expanding cities in Kenya and South Africa. The review has been compiled as part of a larger body of work being conducted by the Institute of Development Studies (IDS) and its partners on gender and international development and financed by the UK Department for International Development (DFID). The review was preceded by a literature search (using keywords to reflect the thematic focus) of key databases of published literature, as well as a search for grey literature and documents describing interventions aimed at addressing these health challenges. An online discussion hosted by IDS gave a further indication of current debates and assisted in the identification of interventions.DFI

Responding to uncertainty: Bats and the construction of disease risk in Ghana

One of a series of seven working papers considering the political economy of One Health.Zoonotic disease has gained international attention since the identification of avian and swine influenza, with academic focus on the modelling of disease emergence, and policy centring on disciplinary approaches of analysis. Recent scholarship has recognised that the conditions which encourage zoonotic diseases are both ecological and socio-political. The challenge lies in the deeply complex causality and high uncertainty in identifying causal links between human, wildlife and livestock diseases. There is a disjuncture between existing academic knowledge on zoonoses and the role that uncertainty plays in anticipating and preventing future outbreaks of as yet unidentified diseases, and the way that policy makers tend to frame such evidence. This paper examines Ghana policy makers’ diverse perspectives on uncertainty related to newly emerging zoonotic diseases through the specific example of fruit bats, showing why it is so difficult to develop appropriate policy for emerging zoonotic disease. These animals have significant potential for zoonotic transmission, as evidenced in the 2014 Ebola outbreak in West Africa. This research predated this outbreak and provides a prescient account of framings of risk, uncertainty and zoonotic disease potential prior to this regional crisis.Ecosystem Services for Poverty Alleviation (ESPA

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

This review identifies evidence on supply-side interventions to change the practices of antibiotic prescribers and gatekeepers in low- and middle-income countries (LMICs). A total of 102 studies met the inclusion criteria, of which 70 studies evaluated interventions and 32 provided insight into prescribing contexts. All intervention studies were from human healthcare settings, none were from animal health. Only one context study examined antibiotic use in animal health. The evidence base is uneven, with the strongest evidence on knowledge and stewardship interventions. The review found that multiplex interventions that combine different strategies to influence behaviour tend to have a higher success rate than interventions based on single strategies. Evidence on prescribing contexts highlights interacting influences including health system quality, education, perceptions of patient demand, bureaucratic processes, profit, competition, and cultures of care. Most interventions took place within one health setting. Very few studies targeted interventions across different kinds of providers and settings. Interventions in hospitals were the most commonly evaluated. There is much less evidence on private and informal private providers who play a major role in drug distribution in LMICs. There were no interventions involving drug detailers or the pharmaceutical companies despite their prominent role in the contextual studies

Local understandings of zoonotic disease should be built into epidemic preparedness and response

People in many global regions can make complex trade-offs between the risk of contracting disease and the need to support their livelihoods, particularly in situations of poverty. Interventions to promote epidemic preparedness should therefore be sensitive to local contexts. These should incorporate knowledge within communities to ensure more effective zoonotic disease surveillance and control, while appreciating broader local priorities for health and well-being