Differential returns from globalization to women smallholder coffee and food producers in rural Uganda

Background: Globalization-related measures to liberalize trade and stimulate export production were applied in Uganda in the late 1980s, including in the coffee production sector, to revitalize agricultural production, increase incomes to farmers and improve rural food security.Objective: To explore the different effects of such measures on the health and dietary outcomes of female coffee and food small holder farmers in Uganda.Methods: We gathered evidence through a cross-sectional comparative interview survey of 190 female coffee producers and 191 female food producers in Ntungamo district. The study mostly employed quantitative methods of data collection, targeting the sampled households. We also utilized qualitative data; collected three months after the household survey data had been collected and their analysis had been accomplished. Using qualitative interviews based on an unstructured interview guide, extra qualitative information was collected from key informants at national, district and community levels. This was among other underlying principles to avoid relying on snapshot information earlier collected at household level in order to draw valid and compelling conclusions from the study. We used indicators of production, income, access to food and dietary patterns, women’s health and health care. Of the two groups selected from the same area, female coffee producers represented a higher level of integration into liberalised export markets.Results: Document review suggests that, although Uganda’s economy grew in the period, the household economic and social gains after the liberalization measures may have been less than expected. In the survey carried out, both food and coffee producers were similarly poor, involved in small-scale production, and of a similar age and education level. Coffeeproducers had greater land and livestock ownership, greater access to  inputs and higher levels of income and used a wider variety of markets than food producers, but they had to work longer hours to obtain these economic returns, and spent more cash on health care and food from commercial sources. Their health outcomes were similar to those of the food producers, but with poorer dietary outcomes and greater food stress.Conclusions: The small-scale women farmers who are producing food cannot rely on the economic infrastructure to give them support for meaningful levels of production. However, despite having higher incomes than their food producing counterparts, the evidence showed that women who are producing coffee in Uganda as an export commodity cannot rely on the income from their crops to guarantee their health and nutritional wellbeing, and that the income advantage gained in coffee-producing households has not translated into consistently better health or food security outcomes. Both groups have limited levels of autonomy and control to address these problems.Key words: Globalization, women’s health, gender, smallholder farmers, Uganda, nutrition, food security, coffee producers, food producer

Business as usual? The role of BRICS co- operation in addressing health system priorities in East and Southern Africa

There has been increased interest in whether “South-­‐South” co-­‐operation by Brazil, Russia, India, China and South Africa (BRICS) advances more equitable initiatives for global health. This article examines the extent to which resolutions, commitments, agreements and strategies from BRICS and Brazil, India and China (BIC) address regionally articulated policy concerns for health systems in East and Southern Africa (ESA) within areas of resource mobilization, research and development and local production of medicines, and training and retention of health workers. The study reviewed published literature and implemented a content analysis on these areas in official BRICS and ESA regional policy documents between 2007 and 2014. The study found encouraging signals of shared policy values and mutuality of interest, especially on medicines access, although with less evidence of operational commitments and potential divergence of interest on how to achieve shared goals. The findings indicate that African interests on health systems are being integrated into south-­‐south BRICS and BIC platforms. It also signals, however, that ESA countries need to proactively ensure that these partnerships are true to normative aims of mutual benefit, operationalize investments and programs to translate policy commitments into practice and strengthen accountability around their implementation

Medicalization of global health 2: the medicalization of global mental health

Once an orphan field, ‘global mental health’ now has wide acknowledgement and prominence on the global health agenda. Increased recognition draws needed attention to individual suffering and the population impacts, but medicalizing global mental health produces a narrow view of the problems and solutions. Early framing by advocates of the global mental health problem emphasised biological disease, linked psychiatry with neurology, and reinforced categories of mental health disorders. Universality of biomedical concepts across culture is assumed in the globalisation of mental health but is strongly disputed by transcultural psychiatrists and anthropologists. Global mental health movement priorities take an individualised view, emphasising treatment and scale-up and neglecting social and structural determinants of health. To meet international targets and address the problem's broad social and cultural dimensions, the global mental health movement and advocates must develop more comprehensive strategies and include more diverse perspectives

Governance Challenges in International Health Financing and Implications for the New Pandemic Fund

Abstract Background: The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. Methods/ results: To better situate the Pandemic Fund within discussions about existing challenges in global health financing, this article presents the results of a scoping review identifying key challenges associated with international health financing instruments. A total of 73 documents were collected from which 51 were reviewed for analysis. Thematic analysis identified eight thematic groupings that emerged from the literature which were then used as policy criteria to assess the current governance and financing design of the Pandemic Fund using available information on the Fund. The eight themes in hierarchical order of frequency were: misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Assessment of the Pandemic Fund against these criteria found that although some mechanisms have been adopted to recognise and address challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. Conclusion: It remains unclear how the Pandemic Fund is explicitly addressing the eight challenges identified. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers three sets of policy recommendations for how the Pandemic Fund and PPR financing architecture might respond more effectively to the identified challenges.</jats:p

Challenges in international health financing and implications for the new pandemic fund

Background The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. Methods/Results The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. Conclusion It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges

Prevalence and ergonomic risk factors of work-related musculoskeletal injuries amongst underground mine workers in Zambia

Work-related musculoskeletal injuries (WMSIs) are common in both developed and third world countries. Most researchers agree that exposure to ergonomic risk factors is a major contributor to these injuries. Objective: The aim of this study was to determine the prevalence of and ergonomic risk factors associated with WMSIs amongst underground mine workers in Kitwe, Zambia. Methods: A cross-sectional quantitative study was conducted using a sample size of 500 workers. A stratified random sampling method according to mining work activity type was used to obtain the sample. Data was collected by means of a structured questionnaire, and the Statistical Package for Social Sciences (SPSS) was used to analyze data using descriptive and inferential statistical methods. Results were significant at 5%. Results: A response rate of 40.4% (202) was obtained. The 12-month prevalence of WMSIs was 42.6%. The mean age of the workers was 40.31 years (SD +/− 8.57 years). Electricians and mechanics reported the highest injury frequencies. The back was the most affected body part. Ergonomic risk factors consistently reported by workers included poor postures and heavy lifting. There were significant (p=0.020) associations between working with the back bent and sustaining a back injury. Significant (p=0.049) associations were also found between injuries of the wrists/hands and grasping an unsupported object(s). Conclusions: This study revealed significant associations between WMSIs and ergonomic risk factors like working with the back bent and grasping object.Web of Scienc

Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Background: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity. Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences. Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration. Conclusions:The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach

Reclaiming comprehensive public health

Global and national responses to the COVID-19 pandemic highlight a long-standing tension between biosecurity-focused, authoritarian and sometimes militarised approaches to public health and, in contrast, comprehensive, social determinants, participatory and rights-based approaches. Notwithstanding principles that may limit rights in the interests of public health and the role of central measures in some circumstances, effective public health in a protracted pandemic like COVID-19 requires cooperation, communication, participatory decision-making and action that safeguards the Siracusa principles, respect for people’s dignity and local-level realities and capacities. Yet there is mounting evidence of a dominant response to COVID-19 where decisions are being made and enforced in an overcentralised, non-transparent, top-down manner, often involving military coercion and abuse in communities, even while evidence shows the long-term harm to public health and human rights. In contrast, experiences of comprehensive, equity-focused, participatory public health approaches, which use diverse sources of knowledge, disciplines and capabilities, show the type of public health approach that will be more effective to meet the 21st century challenges of pandemics, climate, food and energy crises, growing social inequality, conflict and other threats to health

Occupational illnesses in the 2009 Zambian labour force survey

<p>Abstract</p> <p>Background</p> <p>Occupational health has received limited research attention in the Southern African Development Community (SADC). Much of the published data in this region come from South Africa and little has been reported north of the Limpopo. The present study was conducted to estimate the burden of occupational illnesses in Zambia and assess factors associated with their occurrence.</p> <p>Methods</p> <p>Data were obtained from the Zambian Labour Force Survey of 2009. Frequencies were used to estimate the prevalence of occupational diseases. Logistic regression analyses were conducted to determine the associations between demographic, social and economic factors and reported illness resulting from occupational exposures. Odds ratios (OR) from bivariate analyses and adjusted odds ratios (AOR) from the multivariate analysis together with their 95% Confidence Intervals (CI) are reported.</p> <p>Results</p> <p>Data on 59,118 persons aged 18 years or older were available for analysis, of which 29805 (50.4%) were males. The proportions of the sample that reported to have suffered from an occupational illness were 12.7% among males and 10.4% among females (p < 0.001). Overall the proportions of respondents who reported suffering from fatigue, fever and chest infections were 38.8%, 21.7% and 17.1%, respectively. About two thirds (69.7%) of the study participants had stayed away from work due to the illness suffered at work; there was no sex differences (p = 0.216). Older age, being male, lower education level, married/cohabiting or once married (separated/divorced/widowed), and paid employee or employer/self employed were positively associated with having suffered from illness.</p> <p>Conclusions</p> <p>The findings from this study call for urgent effort for specific measures to prevent and mitigate the effects of occupational injuries. These interventions may include: public health campaigns, enforcement or change in work policies and regulations. Special attention may have to be made towards those who were more likely to suffer from occupational illnesses.</p

'Issues of equity are also issues of rights': Lessons from experiences in Southern Africa

BACKGROUND: Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. METHODS: The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. RESULTS: Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. CONCLUSION: Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity