Confirming Domestic Identity, Supporting Public Commitment (the Case of Tuan Guru\u27s Wife in Lombok West Nusa Tenggara Eastern Indonesia)

Berbeda dengan Tuan Guru (pemimpin agama) yang merupakan figure penting dan berpengaruh, bukan hanya agama tetapi juga politik dan budaya, di Lombok, para istri mereka bukanlah tokoh dunia publik. Pengamatan demikian mungkin saja mengindikasikan terjadinya proses domestikasi yang lalu mengakibatkan subordinasi dalam relasi keluarga Tuan Guru. Penelitian ini menawarkan nuansa dan pemahaman lain dalam melihat relasi gender pada keluarga Tuan Guru, dengan menggarisbawahi cairnya demarkasi ruang public dan private yang terjadidi dalamnya. Penelitian ini mengungkap bagaimana sesungguhnya para istri Tuan Guru memposisikan dirinya dalam relasi kuasa pernikahan yang memberikan kesan bahwa relasi gender itu tidak linier dan kaku tetapi kompleks dan cair. Pembagian ruang public dan private adalah isu penting bagi gerakan feminis.Agama, negara, dan keluarga dikritisasi sebagai lembaga-lembaga yang melanggengkan istrinisasi karena mereka masing-masing adalah dasar bagi, alat untuk, dan tempat bagi suburnya budaya patriarkhi. Ideologi gender yang dianut oleh Indonesia sebagaimana yang termaktub dalam UU perkawinan No 1/1974 misalnya membenarkan dikotomi laki-laki sebagai kepala keluarga dan perempuan adalah iburumah tangga. Negara,melalui system hukumnya, secara aktif memapankan pembagian yang kaku ini sembari menyamarkan berbagai fakta yang terjadi tentang bagaimana sesungguhnya perempuan Indonesia menegosiasikan pembagian yang kaku tersebut. Berdasarkan interview mendalam dengan para istri Tuan Guru dari tiga pondok pesantren yang terbesar di Lombok, penelitian ini mengungkap bahwa pembagian ruang public dan privat dalam keluarga Tuan Guru adalah sebuah cara untuk menegaskan identitas domestic seorang istri dan mendukung komitmen publik para Tuan Guru. Dalam beberapa poin, cara pandang ini memang mengadopsi ideologi yang ditanamkan oleh Negara sebagaimana dikemukakan di atas, tetapi dengan beberapa modifikasi. Garis pemisah antara ruang public dan domestic tidak selalu jelas karena para istripun bertanggungjawab dan terlibat aktif dalam kehidupan pesantren termasuk dalam bidang managemen, pendidikan, keuangan serta aktif berpartisipasi dalam pengembangan dan tanggungjawab social lembaga pesantren. Keterlibatan public istri tuan guru tersebut, hanya saja, bukan atas nama gerakan aktivisme atau pembebasan perempuan, tetapi lebih sebagai mendaulatkan diri mereka sebagai pemain belakang layar yang sangat menentukan keberhasilan perjuangan sosial para Tuan Guru. Di sinilah letak kompleksitas relasi gender itu

How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan

Background: Limited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities. Methods and findings: A system dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse and switch antenatal care services in four provider sectors: public, private, traditional and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different subgroups by geographical locations and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences on if, when and where to seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within trimester 2, but for rural women within trimester 1. Antenatal care access delayed to trimester 3 had no protective impact on neonatal mortality. Conclusions: System dynamics modelling enables capturing the complexity of health-seeking behaviours and impact on outcomes, informing intervention design, implementation of targeted policies and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts and strong social network influences

Investing in emerging infectious diseases: a systematic analysis of UK research

Background: Emerging and infectious diseases threaten health, security, and the global economy. However, little is known about investments in research to tackle outbreaks and innovate new tools for infectious disease control.Methods & Materials: We systematically searched databases and websites for information on research investments for the period 1997-2010. We identified 325,922 studies for screening, included 6,165 studies in the initial analysis, and identified 654 studies on emerging infectious diseases in the final analysis.Results: We identified a total research investment in emerging infectious diseases of £199 million, accounting for 7.7% of a total research investment in infectious diseases of £2.6 billion. In comparison, investment in HIV research amounted to £478 million (18.4% of total investment).Diagnostic tools for control accounted for £9.8 million (4.9%) across 66 studies. Studies assessing therapeutics accounted for £20.0 million (9.9%) across 35 studies. Vaccine research attracted the least funding for tools to tackle emerging infectious diseases, with £11.5 million (5.8%) across 24 studies.Hepatitis C received the most investment with £59.7 million (30.0%), followed by prion research with £33.5 million (16.8%), Campylobacter jejuni with £24.1 million (12.1%), and Helicobacter pylori with £15.1 million (7.6%). Although total influenza investment was £80.1 million, funding specifically for H5N1 influenza virus was £13.7 million (6.9%) and for H1N1 influenza virus was £10.8 million (5.4%).Public funding accounted for £144.0 million (72.3%) across 361 studies with philanthropic funding awarding £40.6 million (20.4%) across 173. Preclinical research attracted the most investment with £142.4 million (71.5%) followed by epidemiological and operational research with £42.1 million (21.2%) and product development research with £12.2 million (6.1%). Phase 1, 2, 3 clinical trials was the least well-funded type of research with £2.5 million (1.2%).Conclusion: Emerging infectious diseases receives small amounts of funding compared to other scientific disciplines, with the exception of HIV. It is essential that we map, monitor and evaluate emerging infectious disease research funding given their importance to global health security

Financing essential HIV services: a new economic agenda.

Anna Vassall and colleagues discuss the need for, and challenges facing, innovative and sustainable financing of the HIV response. Please see later in the article for the Editors' Summary

The Directly Observed Therapy Short-Course (DOTS) strategy in Samara Oblast, Russian Federation

BACKGROUND: The World Health Organisation (WHO) defines Russia as one of the 22 highest-burden countries for tuberculosis (TB). The WHO Directly Observed Treatment Short Course (DOTS) strategy employing a standardised treatment for 6 months produces the highest cure rates for drug sensitive TB. The Russian TB service traditionally employed individualised treatment. The purpose of this study was to implement a DOTS programme in the civilian and prison sectors of Samara Region of Russia, describe the clinical features and outcomes of recruited patients, determine the proportion of individuals in the cohorts who were infected with drug resistant TB, the degree to which resistance was attributed to the Beijing TB strain family and establish risk factors for drug resistance. METHODS: prospective study RESULTS: 2,099 patients were recruited overall. Treatment outcomes were analysed for patients recruited up to the third quarter of 2003 (n = 920). 75.3% of patients were successfully treated. Unsuccessful outcomes occurred in 7.3% of cases; 3.6% of patients died during treatment, with a significantly higher proportion of smear-positive cases dying compared to smear-negative cases. 14.0% were lost and transferred out. A high proportion of new cases (948 sequential culture-proven TB cases) had tuberculosis that was resistant to first-line drugs; (24.9% isoniazid resistant; 20.3% rifampicin resistant; 17.3% multidrug resistant tuberculosis). Molecular epidemiological analysis demonstrated that half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Drug resistance including MDR TB was strongly associated with infection with the Beijing strain (for MDR TB, 35.2% in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2. Risk factors for multidrug resistant tuberculosis were: being a prisoner (OR 4.4), having a relapse of tuberculosis (OR 3.5), being infected with a Beijing family TB strain (OR 6.5) and having an unsuccessful outcome from treatment (OR 5.0). CONCLUSION: The implementation of DOTS in Samara, Russia, was feasible and successful. Drug resistant tuberculosis rates in new cases were high and challenge successful outcomes from a conventional DOTS programme alone