Why agricultural production in sub-Saharan Africa remains low compared to the rest of the world – a historical perspective

Agricultural production in sub-Saharan Africa has, in recent times, remained lower than the rest of the world. Many attribute this to factors inherent to Africa and its people, such as climate, soil quality, slavery and disease. This article traces the role of agriculture through history and argues that these are not the main reasons. Before the arrival of European traders, complex agricultural systems existed, which supported food security, manufacturing and trade. External interference manipulated these systems in pursuit of export crops. Independence has not fundamentally changed this; resource and wealth extraction continue to inhibit economic development for Africans in Africa

Involving Stakeholders in Crop-Livestock Systems Analysis: Innovation Platforms in Burkina Faso and Niger, West Africa

The development of markets and agricultural productivity need participative research approaches that involve farmers, stakeholders and actors in the value chains of agricultural products and inputs. This study illustrates the use of multi-stakeholder platforms to address critical issues that often curtail effective implementation of development strategies and achievement of objectives. The process used to facilitate stakeholder participation and achieve enhanced understanding of collective actions to achieve objectives is illustrated by case studies in Niger and Burkina Faso. The process that determines the causal relationships among the various problems is also presented; results from the process can be used to determine entry points for addressing system challenges. Finally, the study offers specific insights and analysis related to small-ruminant and feed value chains within Niger and Burkina Faso. The strengths and weaknesses of each node of the value chain are assessed and appropriate upgrading, management, and development strategies suggested. Entry points for action and strategies for intervention are identified to improve functioning of the crop-livestock value chain and the productivity of agro-pastoral farming systems. Participative analysis and understanding of the functioning of agricultural value chains enable farmers and actors to improve agricultural productivity and marketing. The multi-stakeholder platform approach is a more suitable tool for socio-economic analysis of integrated systems, and identification and implementation of development strategies, than traditional disciplinary research approaches

Supporting Treatment for Anti-Retroviral Therapy (START) together: protocol for a pilot, randomized, couple-based intervention to promote women's ART adherence and men's engagement in HIV care in KwaZulu-Natal, South Africa

Background: South Africa currently has the greatest number of people with HIV globally. The country has not yet met its 95-95-95 goals, with different gaps in the HIV care cascade for women and men. This paper reports on a protocol to pilot test a couple-based intervention designed to improve women's antiretroviral therapy (ART) adherence and men's engagement in care in heterosexual couples living in the Vulindlela area of KwaZulu-Natal, South Africa. Study goals are two-fold: (1) assess the acceptability, feasibility, and fidelity of the experimental intervention, START Together, and (2) collect efficacy data on START Together for women's ART adherence, men's engagement in HIV care, and the couple's relationship functioning. Methods: Women (N = 20) who were not engaged with ART adherence (defined via self-reported ART difficulties, record of missed clinic visits, or viral non-suppression) are the target patients; male partners are not required to know or disclose their HIV status to be part of the study. Couples are randomized 1:1 to the experimental treatment (START Together) or treatment as usual (referrals to the local clinic to support ART adherence or any other HIV-related care). START Together is a 5-session intervention based in cognitive-behavioral couple therapy, which is a skill-based intervention focusing on communication and problem-solving skills, and Life Steps, a problem-solving intervention identifying barriers and solutions to medication adherence. Couples are assessed at baseline, post-treatment (8 weeks post-randomization), and follow-up (12 weeks post-randomization). Conclusion: This study will provide preliminary implementation and efficacy data on whether this novel approach has potential to improve women and men's HIV and healthcare-related needs

Exploring the factors causing the poor performance of most irrigation schemes in post-independence sub-Saharan Africa

This article explores the factors causing the current poor performance of most government irrigation schemes in sub-Saharan Africa. The literature review finds that the poor performance is not primarily caused by socioeconomic and biophysical conditions inherent to sub-Saharan Africa. African farmers have adapted to diverse biophysical conditions and expanded or contracted their area under agricultural water management in response to market signals. Rather, this poor performance is predominantly linked to the production systems introduced during colonialism and developments since independence, such as agricultural policies restraining rural economic development, unsuitable irrigation technologies and agricultural practices, and international lending practices and trade arrangements

Production decisions and food security outcomes of smallholder’s livestock market participation: empirical evidence from Zimbabwe

Smallholder market participation is an important pathway to improving the productivity and livelihoods of farm households. Despite several studies documenting the effect of market participation on crop production, relatively little is known about the effect of smallholder participation in livestock markets. We investigate effects of smallholder market participation on livestock production and household food security in Zimbabwe. Using survey data collected from 625 households and an instrumental variables strategy to address endogeneity concerns, we find that households participating in livestock markets are more likely to engage in market-oriented livestock production, use improved livestock inputs, and have better food security outcomes. While market participants are more likely to consider market conditions in their decisions, most farmers are needs-driven and cannot afford to adopt commercial-oriented behavior. Overall, smallholder livestock production systems respond to market incentives and can support food security strategies, particularly in drylands where crop production is risky

An overview of extension use in irrigated agriculture and case studies in south-eastern Africa

This study provides an overview of extension influence on the adoption of irrigation innovations in developed and developing countries, and finds that extension plays a more significant positive role in influencing soft technology adoption in developing countries. Case studies on the nature, use and availability of extension advice in six irrigation schemes in Tanzania, Mozambique and Zimbabwe are presented. The use of government extension officers varied significantly, with extension use not linked to farm outcomes. The results suggest the need to support more diverse sources of advice and to promote institutional reform in south-eastern Africa

Health Diplomacy the Adaptation of Global Health Interventions to Local Needs in sub-Saharan Africa and Thailand: Evaluating Findings from Project Accept (HPTN 043).

Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of 'global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation. Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of 'youth-friendly' services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective

Irrigating Africa: policy barriers and opportunities for enhanced productivity of smallholder farmers

African governments have ambitious plans to expand irrigated agriculture, though existing smallholder schemes have largely failed to use land and water sustainably or become profitable. Six government-owned irrigation schemes in Mozambique, Tanzania and Zimbabwe were assessed to identify common policy barriers and opportunities for higher productivity among smallholder farmers. Issues like insecure land tenure systems, unclear institutional arrangements and poor access to markets have contributed to limited profitability. Reform of currently insecure land tenure, strengthening farmer organizations and reforming policies are recommended so that governments step back from scheme management and foster market linkages to enable more profitable irrigated agriculture

Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa

Objectives This qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC). Setting Community setting in Kwa-Zulu Natal, South Africa. Participants Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender. Intervention A couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up. Analysis The transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible. Results Many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors and open discussion of personal barriers to CHTC during couples’ counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples’ perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs and managing negative emotions. Conclusions In-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views

Messaging Circumstances and Economic Pressures as Influences on Linkage to Medical Male Circumcision following Community-Based HIV Testing for Men in Rural Southwest Uganda: A Qualitative Study

Voluntary medical male circumcision (MMC) reduces risk of HIV infection, but uptake remains suboptimal among certain age groups and locations in sub-Saharan Africa. We analysed qualitative data as part of the Linkages Study, a randomized controlled trial to evaluate community-based HIV testing and follow-up as interventions promoting linkage to HIV treatment and prevention in Uganda and South Africa. Fifty-two HIV-negative uncircumcised men participated in the qualitative study. They participated in semistructured individual interviews exploring (a) home HTC experience; (b) responses to test results; (c) efforts to access circumcision services; (d) outcomes of efforts; (e) experiences of follow-up support; and (f) local HIV education and support. Interviews were audio-recorded, translated, transcribed, and summarized into “linkage summaries.” Summaries were analysed inductively to identify the following three thematic experiences shaping men's circumcision choices: (1) intense relief upon receipt of an unanticipated seronegative diagnosis, (2) the role of peer support in overcoming fear, and (3) anticipation of missed economic productivity. Increased attention to the timing of demand creation activities, to who delivers information about the HIV prevention benefits of MMC, and to the importance of missed income during recovery as a barrier to uptake promises to strengthen and sharpen future MMC demand creation strategies