The terrain of urbanisation process and policy frameworks: A critical analysis of the Kampala experience

Kampala is urbanising in an unplanned manner, but without a clear picture of the underlying dynamics. The city is characterised by lack of proper zoning of economic activities and construction of physical infrastructure without regard to subsequent spatial quality and environmental conservation. Consequently, there are sharp differences in residential standards where expensive housing and luxury flats co-exist with shanty towns and informal settlements, with about 60% of the city’s population living in unplanned informal settlements and often faced with challenges of unemployment. The unprecedented increase in the urban population in Kampala and the prospects for further increases in the near future have economic and social implications concerning employment, housing, education and health, among others. Understanding the nature of the dynamics of the growth or decline of cities like Kampala helps planners to support the processes that lead to harmonious urban development and to deal with the negative consequences of urban growth. This paper reflects the urbanisation dynamics explaining Kampala’s urbanisation process with the view to analysing the implications for an alternative urban policy framework. It argues that the conditions that have allowed the situation to exist have serious policy implications which require the need for an integrated policy framework that can be used to effectively prevent or halt Kampala’s unplanned urbanisation while promoting planned urbanisation. Induced by the migration and lack of information, understanding urban dynamics is crucial to the development of urban policies that can effectively ensure that further urban changes occur in a systematic and satisfactory manner. The current urban process in developing countries like Uganda is associated with poverty, environmental degradation and population demands that outstrip service capacity

Impact of the MEMA kwa Vijana adolescent sexual and reproductive health interventions on use of health services by young people in rural Mwanza, Tanzania: results of a cluster randomized trial.

PURPOSE: To assess the impact of an adolescent sexual health intervention on the use of health services by young people in Tanzania. METHODS: Twenty communities, including 39 health facilities, were randomly allocated to the intervention or comparison arm. Health workers from the intervention arm were trained in the provision of youth-friendly health services, as part of a package of interventions. Independent process evaluations were conducted in health facilities, and simulated patients visited clinics using sexual and reproductive health problem scenarios. The impact on health facility attendances were assessed in 1998 (baseline) and 1999-2001. Reported sexually transmitted infection (STI) symptoms and use of health services were evaluated in young people in the trial cohort. RESULTS: The mean monthly attendance for STI symptoms per health facility, per month was .5 for young males and 1.0 for young females at baseline. Attendance by young males was greater in the intervention communities in 1999-2000 after adjustment for baseline differences (p = .005), and this difference increased over time (p-trend = .022). The mean difference in attendance was however relatively modest, at 1.1 per month in 2001 after adjustment for baseline (95% CI: .5, 1.7). There was weaker evidence of an intervention effect on attendance by young women (p = .087). Few condoms were distributed, although a greater number were distributed in intervention facilities (p = .008). Generally, intervention health workers tended to be less judgmental and provided more comprehensive information. CONCLUSIONS: Training staff to provide more youth-friendly health services can increase the utilization of health services for suspected STIs by young people, especially among young men

Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial.

OBJECTIVE: The impact of a multicomponent intervention programme on the sexual health of adolescents was assessed in rural Tanzania. DESIGN: A community-randomized trial. METHODS: Twenty communities were randomly allocated to receive either a specially designed programme of interventions (intervention group) or standard activities (comparison group). The intervention had four components: community activities; teacher-led, peer-assisted sexual health education in years 5-7 of primary school; training and supervision of health workers to provide 'youth-friendly' sexual health services; and peer condom social marketing. Impacts on HIV incidence, herpes simplex virus 2 (HSV2) and other sexual health outcomes were evaluated over approximately 3 years in 9645 adolescents recruited in late 1998 before entering years 5, 6 or 7 of primary school. RESULTS: The intervention had a significant impact on knowledge and reported attitudes, reported sexually transmitted infection symptoms, and several behavioural outcomes. Only five HIV seroconversions occurred in boys, whereas in girls the adjusted rate ratio (intervention versus comparison) was 0.75 [95% confidence interval (CI) 0.34, 1.66]. Overall HSV2 prevalences at follow-up were 11.9% in male and 21.1% in female participants, with adjusted prevalence ratios of 0.92 (CI 0.69, 1.22) and 1.05 (CI 0.83, 1.32), respectively. There was no consistent beneficial or adverse impact on other biological outcomes. The beneficial impact on knowledge and reported attitudes was confirmed by results of a school examination in a separate group of students in mid-2002. CONCLUSION: The intervention substantially improved knowledge, reported attitudes and some reported sexual behaviours, especially in boys, but had no consistent impact on biological outcomes within the 3-year trial period

A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme.

This study is a process evaluation of the school component of the adolescent sexual health programme MEMA kwa Vijana (MkV), which was implemented in 62 primary schools in rural Mwanza, Tanzania from 1999 to 2001. The MkV curriculum was a teacher-led and peer-assisted programme based on the Social Learning Theory. Process evaluation included observation of training sessions, monitoring and supervision, annual surveys of implementers, group discussions and 158 person-weeks of participant observation. Most teachers taught curriculum content well, but sometimes had difficulty adopting new teaching styles. Peer educators performed scripted dramas well, but were limited as informal educators and behavioural models. The intervention appeared successful in addressing some cognitions, e.g. knowledge of risks and benefits of behaviours, but not others, e.g. perceived susceptibility to risk. MkV shared the characteristics of other African school-based programmes found to be successful, and similarly found significant improvements in self-reported behaviour in surveys. However, a substantial proportion of MkV survey self-reports were inconsistent, there was no consistent impact on biological markers and extensive process evaluation found little impact on several key theoretical determinants of behaviour. Improvements in self-reported survey data alone may provide only a very limited-and perhaps invalid-indication of adolescent sexual health programme success

Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial

Objective: The impact of a multicomponent intervention programme on the sexual health of adolescents was assessed in rural Tanzania. Design: A community-randomized trial. Methods: Twenty communities were randomly allocated to receive either a specially designed programme of interventions (intervention group) or standard activities (comparison group). The intervention had four components: community activities; teacher-led, peer-assisted sexual health education in years 5-7 of primary school; training and supervision of health workers to provide 'youth-friendly' sexual health services; and peer condom social marketing. Impacts on HIV incidence, herpes simplex virus 2 (HSV2) and other sexual health outcomes were evaluated over approximately 3 years in 9645 adolescents recruited in late 1998 before entering years 5, 6 or 7 of primary school. Results: The intervention had a significant impact on knowledge and reported attitudes, reported sexually transmitted infection symptoms, and several behavioural outcomes. Only five HIV seroconversions occurred in boys, whereas in girls the adjusted rate ratio (intervention versus comparison) was 0.75 [95% confidence interval (CI) 0.34, 1.66]. Overall HSV2 prevalences at follow-up were 11.9% in male and 21.1% in female participants, with adjusted prevalence ratios of 0.92 (CI 0.69, 1.22) and 1.05 (CI 0.83, 1.32), respectively. There was no consistent beneficial or adverse impact on other biological outcomes. The beneficial impact on knowledge and reported attitudes was confirmed by results of a school examination in a separate group of students in mid-2002. Conclusion: The intervention substantially improved knowledge, reported attitudes and some reported sexual behaviours, especially in boys, but had no consistent impact on biological outcomes within the 3-year trial period

From trial intervention to scale-up: costs of an adolescent sexual health program in Mwanza, Tanzania.

OBJECTIVE: To estimate annual costs of a multifaceted adolescent sexual health intervention in Mwanza, Tanzania, by input (capital and recurrent), component (in-school, community activities, youth-friendly health services, condom distribution), and phase (development, startup, trial implementation, scale-up). STUDY DESIGN: Financial and economic providers' costs and intervention outputs were collected to estimate annual total and unit costs (1999-2001). The incremental financial budget projects funding requirements for scale-up within an integrated model. RESULTS: The 3-year economic costs of trial implementation were US dollars 879,032, of which approximately 70% were for the school-based component. Costs of initial development and startup were relatively substantial ( approximately 21% of total costs); however, annual costs per school child dropped from US dollars 16 in 1999 to US dollars 10 in 2001. The incremental scale-up cost is approximately 1/5 of ward trial implementation running costs. CONCLUSIONS: Annual costs can reduce by almost 40% as project implementation matures. When scaled up, only an additional US dollars 1.54 is needed per pupil per year to continue the intervention