Orange maize in Zambia: crop development and delivery experience

Biofortified vitamin A “orange” maize can help address the adverse health effects of vitamin A deficiency. By 2016, HarvestPlus and its partners had developed six orange maize varieties and delivery efforts have reached more than 100,000 farming households in Zambia. HarvestPlus has established the proof of concept, that vitamin A maize varieties can be developed without compromising yield levels and that these varieties can deliver sufficient quantities of vitamin A to improve nutrition. The delivery program has also shown that farmers are willing to grow orange maize varieties and consumers are willing to buy and eat orange maize products. This paper summarizes the country’s nutritional and consumer backgrounds, the crop development and release of orange maize varieties, the delivery efforts in Zambia and impact measurement. It also synthesizes lessons learned and future challenges.Keywords: Biofortification, Vitamin A Deficiency, Orange Maize, Vitamin A Maize, Zambi

Adherence Support Workers: A Way to Address Human Resource Constraints in Antiretroviral Treatment Programs in the Public Health Setting in Zambia

BACKGROUND: In order to address staff shortages and improve adherence counseling for people on antiretroviral therapy (ART), the Zambia Prevention, Care and Treatment Partnership (ZPCT) developed an innovative strategy of training community volunteers to provide adherence support at the health facility and community levels. The objective of this study was to assess the effectiveness of these 'adherence support workers' (ASWs) in adherence counseling, treatment retention and addressing inadequate human resources at health facilities.METHODOLOGY/PRINCIPAL FINDINGS: The study used quantitative and qualitative research techniques at five selected ART sites in four provinces in Zambia. Five hundred patients on ART were interviewed using a structured questionnaire to compare the quality of adherence counseling before and after the ASW scheme was introduced at the selected sites and between ASWs and HCWs after the introduction of ASWs. In addition, 3,903 and 4,972 electronic records of all new patients accessing antiretroviral therapy for the time period of 12 months before and 12 months after the introduction of ASWs respectively, were analyzed to assess loss to follow-up rates. Two focus group discussions with ASWs and health care workers (HCWs) were conducted in each clinic. Key informant interviews in the ART clinics were also conducted. There was a marked shift of workload from HCWs to ASWs without any compromise in the quality of counseling. Quality of adherence counseling by ASWs was comparable to HCWs after their introduction. The findings suggest that the deployment of ASWs helped reduce waiting times for adherence counseling. Loss to follow-up rates of new clients declined from 15% to 0% after the deployment of ASWs.CONCLUSION: Adherence counseling tasks can be shifted to lay cadres like ASWs without compromising the quality of counseling. Follow-up of clients by ASWs within the community is necessary to improve retention of clients on ART

Water, stakeholders and common ground : challenges for multi-stakeholder platforms in water resource management in South Africa

There is a growing global concern about future water supplies. Growing demands from agriculture, industry and urban growth are streching available water supplies while pollution is undermining the quality of the resource base. Physical data available indicate that in South Africa, full utilisation of water resources has been reached and even exceeded in many parts of the country. Now looming is the complete depletion of the overall conventional water resources of the country, which is likely to occur in about 30 years should the efficiencies of water utilisation by different water user sectors not be dramatically improved.Even if a state may have expertise and resources to tackle the looming water problems, a contemporary debate rooted in the neo-liberal democratic thinking argues that the state, because of the inherent shortcomings of its traditional instruments, is not able (any more) to solely solve the economic and social problems it may identify. In order to prevent unwanted developments, it is either necessary to look for alternative instruments or to lower the aspirations of central-state control. This has resulted in trying a flexible repertoire of policy responses including democratisation of resource management. It is anticipated that democratisation of resource management would increase the range of possible solutions and consequently increase social resilience by diversifying governing capabilities. In this instance, stakeholder participation has emerged as an alternative and desirable approach to natural resource management since including civil society in the process of governance logically entails the acceptance of diversity.South Africa, like many other countries, has embraced stakeholder participation in the processes of natural resource management. The new participatory approaches however, contrast the historically simple processes of collective initiatives among more homogenous groups who shared common concerns within a familiar geographical zone. In the new resource management approaches, 'participation' has come to include complex interaction of layers of diverse actors, who make decisions over a large variety of complex ecosystems. Stakeholders participation has brought with it varying models of institutional forms and terminologies which include Participatory Natural Resource Management (NMRM), Co-Management and (Multi)Stakeholder Platforms (MSPs) and other variants - (Multi)Stakeholder Processes, (Multi)Stakeholder Partnerships, (Multi)Stakeholder Dialogues. These new institutional forms promise a considerable shift in the manner in participatory natural resources management is undertaken.Notwithstanding, Multi-Stakeholder participatory approaches are still an unknown theoretical and management territory. Little is known about the potential of establishing institutional designs based on participatory approaches at levels as high as catchments. Furthermore, water itself presents stakeholders with diverse and extreme challenges, ranging from multiple uses, seasonal and spatial variability, to drought and flood disaster situations. For this reason, this study was undertaken to examine the benefits and the challenges of pursuing Multi-Stakeholder Participatory approach in the management of water resources at catchment level.Catchment Management Forums (CMFs), in South Africa's water resource management arena, represented a form of MSPs that constituted the unit of analysis for this study. This research has taken a critical examination of the central issues relating to the emergence and operations of this version of South Africa's MSPs. The study targeted two CMFs in the historically marginalised areas of the Eastern Cape Province - the Mthatha Catchment Management Forum (Mthatha CMF) and the Kat Catchment Management Forum (Kat CMF). Using a combination of research methods and an institutional analysis approach, the study findings unearthed insights, dilemmas and possibilities of considerable relevance to the wider context of developing economies.Evidence examined in this thesis has shown that while the rationale behind MSP approach to water resource management is appealing, several factors create barriers between the ideology and grounded reality especially in developing countries. First, achieving a 'common ground' that facilitates internal collaboration and coherence among participants is highly elusive. This is attributed to the contrast that exists between the general nature of the lifeworlds of two contrasted groups of stakeholders -Organisational Stakeholders (representatives of organisations) and Community Stakeholders (representatives from community groups and villages) who are the fundamental constituents of an MSPs. The absence of a 'common ground', vividly demonstrated in one study area - Mthatha catchment, 1ed to the absence of a shared vision, resulting in varying interpretations of the purpose of the MSP among participants. Second, the examination of the institutionalisation processes revealed that the 'institutional arrangements' as exhibited by CMFs were not appropriate for the anticipated task of these institutions. The study revealed that non-statutory MSPs were hampered by their archaic institutional arrangements, including unstructured administration, lack of mandate and absence of financial support, which rendered the management of complex water regimes that obtained at catchment level a far-fetched objective.Based on the exploration of MSPs that emerge and function as the two studied CMFs, the multi-stakeholder participatory approach is faced with daunting challenges in developing countries. Major argument being that policy formulation regarding stakeholder participation at catchment level, did not match legal and administrative requirements to support these institutions. Based on experiences from Kat catchment, which was fundamentally a community-based MSP, this thesis argues that the success for MSP approaches might lie in enabling grassroot participants to build their own institutions that handle issues according to their own priorities. These can then be further integrated horizontally and vertically into larger associations that transcend individual villages or common customs neighbourhoods to create a web-like institutional framework. The Mthatha case revealed that when confronted with multiple local stakeholders with sanctioned right to press for their needs, actors need not only a platform for dialogue, but also the mandate to act on their voices. Actors need specified property rights, sufficient funds to effect the decisions and government support to produce results

Community-based management of child malnutrition in Zambia: HIV/AIDS infection and other risk factors on child survival

(1) Background: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) Methods: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) Results: The analysis included 858 malnourished children (19 months +/- 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1-6.8), HIV infection (3.1; 1.7-5.5), and WAZ <-3 (3.1; 1.6-5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) Conclusions: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children

Differences in proportions that can be detected in studies with varied sample sizes for variables occurring at various baseline frequencies

<p>Differences in proportions that can be detected in studies with varied sample sizes for variables occurring at various baseline frequencies</p

Proportion of ART clients receiving pre-treatment and follow-up adherence counseling before and after ASW were introduced

<p>Proportion of ART clients receiving pre-treatment and follow-up adherence counseling before and after ASW were introduced</p