Public actors or private providers?: NGOs, Health Sector Reform and Community Based Health Care in Tanzania

The thesis poses two main questions: ‘what are NGOs?’ and ‘where do NGOs fit in?’. Taking the World Development Report of 1993 as the articulation of an international Health Sector Reform (HSR) agenda, the thesis questions the depiction of NGOs as private health service providers. Identifying four themes as key to the conceptualisation, design and implementation of HSR, it reflects on how these themes have been treated in health and development policy and practice. The thesis proposes that the ethos, programmes and actions of NGOs in health shed light on the interpretation of‘private*, ‘health’, ‘decentralisation’ and ‘community’ in ways that uncover important assumptions and contradictions inherent in the HSR agenda. It proposes that rather than taking NGOs to be private health service providers fitting neatly into increasingly market-based health systems, further exploration of the activist and advocacy role of NGOs is justified. Investigating HSR in Tanzania, the thesis shows that the dominant view of NGOs is as private service providers, but that, despite recognition of this role, NGOs have been largely excluded from policy discussions. The thesis takes Community Based Health Care (CBHC) - identified in the HSR policy documents and referred to by NGOs - as a case through which to explore the notion that NGOs are ‘community activists’, with a significance beyond direct health service provision. Promotion of CBHC by NGOs shows how they work in and around the formal health sector, at national, local government, and community levels. It concludes that whether providing primary health services, supporting selective primary health interventions, or promoting comprehensive empowerment-oriented approaches to primary health care, NGOs are embedded in complex processes of defining and meeting ‘public’ need. This merits the reconceptualisation of NGOs as public actors constantly defining, maintaining and developing their role through engagement in networks of public action

Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial.

BACKGROUND: Adolescents living with HIV (ALHIV) experience a high burden of mental health disorder which is a barrier to antiretroviral therapy adherence. In Zimbabwe, trained, mentored peer supporters living with HIV (Community Adolescent Treatment Supporters - CATS) have been found to improve adherence, viral suppression and psychosocial well-being among ALHIV. The Friendship Bench is the largest integrated mental health programme in Africa. We hypothesise that combining the CATS programme and Friendship Bench will improve mental health and virological suppression among ALHIV compared with the CATS programme alone. METHODS: We will conduct a cluster-randomised controlled trial in 60 clinics randomised 1:1 in five provinces. ALHIV attending the control arm clinics will receive standard CATS support and clinic support following the Ministry of Health guidelines. Those attending the intervention arm clinics will receive Friendship Bench problem-solving therapy, delivered by trained CATS. Participants with the signs of psychological distress will be referred to the clinic for further assessment and management. The primary outcome is HIV virological failure (≥1000 copies/ml) or death at 48 weeks. Secondary outcomes include the proportion of adolescents with common mental disorder symptoms (defined as Shona Symptom Questionnaire (SSQ-14) score ≥8), proportion with depression symptoms (defined as Patient Health Questionnaire (PHQ-9) score ≥11), symptom severity (mean SSQ-14 and PHQ-9 scores) and EQ-5D score for health-related quality of life. CONCLUSIONS: This trial evaluates the effectiveness of peer-delivery of mental health care on mental health and HIV viral load among ALHIV. If effective this intervention has the potential to be scaled-up to improve these outcomes.Trial registration: PACTR201810756862405. 08 October 2018

Social Protection, Livelihoods and the Hidden Economy of Care

Dorcas Robinson looks at how ‘social protection’ has increasingly woven its way into the social and economic development discourses. She discusses what social protection means in women's reproductive and productive lives in Tanzania, and argues that social movements can work to build social protection systems for greater economic and social equality.

Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: What remains?

Objective. To examine the remains of the Community-Based Reproductive Health Project (CBRHP) implemented by CARE-Tanzania to address high maternal mortality in two rural districts. Methods. In early 2007, data were collected from 29 villages and used to assess sustainability of emergency transport systems, retention of village health workers (VHWs), and their potential impact on maternal health. Surveillance data from the Ministry of Health were reviewed to assess changes in prenatal and service use indicators. Results. From 2001 through 2006, the CBRHP-trained VHWs have continued to provide education and referrals to women in their communities including prenatal and emergency obstetric care; six villages with emergency transport systems have continued for more than 5 years providing free or low-cost transport to health facilities. Selected maternal and infant health indicators, such as early prenatal care, identification of pregnancy-related danger signs, and data on maternal and infant outcomes, improved in the two targeted districts over time. Conclusions. The two components of CBRHP, work of VHWs and community-financing for emergency transport systems in six villages, have continued. Both of these promote maternal health and linkages with the health delivery systems. Surveillance data show changes in maternal health indicators that were targeted by the district-wide CBRHP interventions. Programs such as CBRHP, with focus on capacity-building and empowerment, can assist in mobilizing the formal and informal systems in communities, components of which may be sustained over time

Integrating fisheries and agricultural programs for food security

Background: Despite the connections between terrestrial and marine/freshwater livelihood strategies that we see in coastal regions across the world, the contribution of wild fisheries and fish farming is seldom considered in analyses of the global food system and is consequently underrepresented in major food security and nutrition policy initiatives. Understanding the degree to which farmers also consume fish, and how fishers also grow crops, would help to inform more resilient food security interventions. Results: By compiling a dataset for 123,730 households across 6781 sampling clusters in 12 highly food-insecure countries, we find that between 10 and 45% of the population relies on fish for a core part of their diet. In four of our sample countries, fish-reliant households are poorer than their counterparts. Five countries show the opposite result, with fish-reliant households having higher household asset wealth. We also find that in all but two countries, fish-reliant households depend on land for farming just as much as do households not reliant on fish. Conclusions: These results highlight the need for food security interventions that combine terrestrial and marine/freshwater programming if we are going to be successful in building a more resilient food system for the world’s most vulnerable people.Science, Faculty ofNon UBCResources, Environment and Sustainability (IRES), Institute forReviewedFacult

Fiskeri-undervisningen 1966 - 1967

The NeuroDev study will deeply phenotype cognition, behavior, dysmorphias, and neuromedical traits on an expected cohort of 5,600 Africans (1,800 child cases, 1,800 child controls, and 1,900 parents) and will collect whole blood for exome sequencing and biobanking