Agricultural intensification and policy interventions: Exploring plausible futures for smallholder farmers in Southern Mali

Assessing how livelihoods in rural sub-Saharan Africa might change given future trends in socio-economic and biophysical conditions helps to identify and direct effective efforts towards poverty reduction. Based on existing literature, hypothetical changes in farmer practices and policy interventions were described and used to build five contrasting scenarios towards the year 2027. A simulation framework was developed to assess food self-sufficiency and income per capita now and in the future for a representative village of 99 households in Southern Mali. In the current situation, 26% of the farms were food self-sufficient and above the 1.9 US$ day−1 poverty line. This percentage would fall to 13% in the “Business as usual” scenario. In the “Dairy development” scenario, with intensification of livestock production and support to the milk sector, 27% of farms would be food self-sufficient and non-poor. Additional policy interventions targeting family planning and job creation outside agriculture would be needed to improve both household food self-sufficiency and income per capita. In this optimistic scenario, 77% of the farms would be non-poor and food self-sufficient in 2027. Additional programs to promote Integrated Pest Management, small-scale mechanization and mineral fertilizer on traditional cereals could allow a drastic increase in productivity and would lift 94% of the farm population out of poverty. Considering the entire heterogeneous farm population was crucial to accurately assess pathways out of poverty. Our study stresses the need for a strategic and multi-sectoral combination of interventions to improve livelihoods

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire.

OBJECTIVE: To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services. METHODS: Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff. RESULTS: HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme. CONCLUSIONS: Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general