The Last Word

A graduate of the Bank Street School for Children explains her love of math and the projects she created while a student in the School.https://educate.bankstreet.edu/progressive/1025/thumbnail.jp

Bottlenecks and benevolence: how the World Bank is helping communities to ‘cope’ with HIV/AIDS

© 2015, SAGE

Public Participation in Health Systems in Zimbabwe

Summary This article outlines some of the challenges faced in moving away from a health system largely planned and governed by technical personnel to one that involves wider public participation and accountability in planning, implementing and monitoring health services. It considers factors that contribute to motivation for changes in approach, and towards a greater degree of community participation in mechanisms for and the governance of health service delivery. Set within the current environment of real declines in access to health care in Zimbabwe, the liberalisation of health providers and consequent demand for informed consumers, the article explores consumer demand for improved quality services and ways to tackle the need to ensure greater impact in resource use. It explores changing roles within health policy reforms and in relation to processes of decentralisation. It considers health service motivations to widen resource mobilisation strategies, and particularly community contributions to health. The article outlines the perceptions of civic groups, elected and traditional leaders and health service providers in how participation should be restructured in Zimbabwe, noting the general call for greater participation in the planning of resource mobilisation and allocation approaches and of monitoring quality of care. It discusses mechanisms for making such a shift, and the issues to be faced in doing so

Epidemiology of the health impact of pesticide use in Zimbabwe

A study of the implications of pesticide exposure to Zimbabwe's occupational health regulations.About 30-50 per cent of the workers on large-scale commercial farms involved in pesticide use in Zimbabwe are exposed to organophosphates during the spraying season. Pesticide exposure is associated with use of manual techniques, little provision of protective clothing and inadequate safety information. There is evidence that pesticide exposure spills over into non-spravers and into the communities living on farms. Hospital admissions for acute poisoning appeal' to be a poor guide to the extent of sub-acute or chronic exposure to pesticides, given the extent of exposure documented in the surveys. The use of simple biological monitoring techniques can be extremely useful in epidemiological assessment of patterns and possible sources of exposure. The findings of the studies reported in this chapter add weight to the growing body of evidence that there is a need for a greater allocation of resources towards identifying and controlling the negative health impact of pesticide use in developing countries

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

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

Participatory action research in health systems : a methods reader

This “reader” in participatory action research (PAR) serves to inform, motivate and strengthen PAR as a research methodology useful for both health policy and systems research. It includes examples of PAR across all income areas and global regions, and provides a selection of readings on the subject. The texts are backed by references and resources, as well as ethics concerns and innovations in the field. Methods and tools for gathering evidence along with context are demonstrated, as well as guidance in the communication of findings. Social determinants of health may be more easily factored in to qualitative and participatory action research endeavours

Equitable recovery from COVID-19 : Bring global commitments to community level

Acknowledgements This paper results from a cooperation between the authors in a project coordinated by Training and Research Support Centre in association with University of Aberdeen on Building policy support for Family and Child Health and Well-being (https://www.shapinghealth.org/case-studies-fchw). We acknowledge the Robert Wood Johnson Foundation and the Charities Aid Foundation of America for support of the project. Funding We acknowledge a prior Robert Wood Johnson Foundation and the Charities Aid Foundation of America (RWJF/CAFA) grant for background work on building policy support for family and child health and wellbeing.Peer reviewedPublisher PD