Rural piped-water enterprises in Cambodia: A pathway to women's empowerment?

© 2019 by the authors. This research examined the extent to which women's ownership and management of water supply schemes led to their empowerment, including their economic empowerment, in rural Cambodia. Privately managed water supply schemes in rural Cambodia serve over one million people. This study is the first of its kind to systematically investigate the experiences and needs of female water supply scheme owners, using well-established theoretical frameworks for women's empowerment, namely Longwe's stages of empowerment, and Rowlands, VeneKlasen and Miller's elaboration on different types of power. Business management frameworks relevant to the water, sanitation and hygiene (WASH) sector were also drawn on to assess operational constraints and enablers. Fifteen structured interviews were conducted with female water entrepreneurs in rural Cambodia. Female entrepreneurs reported encountering four key barriers to establishing and managing water supply schemes. The first were operational, and government and regulatory related issues, followed by financial issues and limited demand for water services. Three important enablers were reported by entrepreneurs: social enablers, economic enablers and program support from government, associations and non-government organisations (NGOs). This study found that, whilst there was evidence of empowerment reported by female water enterprise owners, the complexity of the ongoing empowerment process, challenges and limitations were also observed. Women's empowerment can be advanced through leadership of, and involvement in water enterprises, as evidenced by this study, however, gender norms constrained women, especially with respect to mobility (leaving the home for extended periods), and household and family duties impacting on income-generating work or vice versa. As such, targeted strategies are needed by a range of actors to address such constraints. The findings of this study can assist NGOs, donors and governments incentivizing entrepreneurship in water services, to ensure that these interventions are not gender blind, and to draw on evidence of the barriers and enablers for female entrepreneurs and how these are influenced by contextualized gender norms

Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group (P = 0.03). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF

Performance-based financing as a health system reform : mapping the key dimensions for monitoring and evaluation

Peer reviewedPublisher PD

Gender equality in the government water, sanitation, and hygiene workforce in Indonesia: an analysis through the Gender at Work framework

Gender inequality remains a persistent challenge in workforces globally, with the water, sanitation, and hygiene (WASH) workforce no exception. This paper aimed to investigate gender dynamics in the Indonesian government WASH workforce at national and subnational levels and evolve conceptual foundations for this type of study. The Gender at Work framework (Rao, A., J. Sandler, D. Kelleher, and C. Miller. 2016. Gender at Work: Theory and Practice for 21st Century Organizations. London: Routledge), provided a framing to support critical examination of power relations embedded in institutions and communities. In-depth interviews were undertaken with 52 government employees in the districts of Sumbawa and Manggarai and two national ministries. The findings identified four important themes which hinder or support gender equality in the Indonesian government WASH workforce: (a) career progression, continued education, and professional ambitions; (b) gender equality and gendered social dynamics in the workplace; (c) family and institutional support; and (d) gender-based violence and safety in the workplace. Our findings also generated insights on intersectional aspects, including people of different ethnic origins, pointing to the need to explicitly account for these in frameworks such as the Gender at Work framework. Through the identification and consideration of ‘gendered substructures’ this research provides a basis to promote greater equality in the WASH workforce

Female Water Entrepreneurs in Cambodia: Considering enablers and barriers to women’s empowerment, Enterprise in WASH – Research Report 9

In 2015 there were an estimated 300 privately managed water supply schemes in rural Cambodia, serving over onemillion people (World Bank, 2015,p. 15). In recent years, a range of policies has been put in place by the Cambodian Government to promote gender equality within the rural water and sanitation sector. One such policy is theCambodian National Strategy for Rural Water Supply (2011–2025),whichincludesprovisions to increase gender equality. One of the ways the Strategy aims to do this is by: ‘Mainstream[ing]gender in the [rural water supply] sector’ (Cambodian Government, 2011, p.10). However, there are major knowledge gaps related to how gender norms intersect with the rural water sector, and with the growth of water enterprises in Cambodia. These gaps include:a lack of knowledge about how gender influences who becomes a water entrepreneur; what the experiences, challenges and opportunities of water entrepreneurs are; and how water entrepreneurship relates towomen’s empowerment, including economic empowerment. To begin to address these knowledge gaps, this study examined the extent to whichwomen’s ownership and management of water supply schemes led to their empowerment, including economic empowerment. This study, and a related concurrent study in Indonesia,arethe first of their kind to systematically look into the experiences and needs of female water supply scheme entrepreneurs(henceforth referred to as “entrepreneurs”), and the first to explore their experiences with reference to women’s empowerment frameworks

Mild cold effects on hunger, food intake, satiety and skin temperature in humans.

BACKGROUND: Mild cold exposure increases energy expenditure and can influence energy balance, but at the same time it does not increase appetite and energy intake. OBJECTIVE: To quantify dermal insulative cold response, we assessed thermal comfort and skin temperatures changes by infrared thermography. METHODS: We exposed healthy volunteers to either a single episode of environmental mild cold or thermoneutrality. We measured hunger sensation and actual free food intake. After a thermoneutral overnight stay, five males and five females were exposed to either 18°C (mild cold) or 24°C (thermoneutrality) for 2.5 h. Metabolic rate, vital signs, skin temperature, blood biochemistry, cold and hunger scores were measured at baseline and for every 30 min during the temperature intervention. This was followed by an ad libitum meal to obtain the actual desired energy intake after cold exposure. RESULTS: We could replicate the cold-induced increase in REE. But no differences were detected in hunger, food intake, or satiety after mild cold exposure compared with thermoneutrality. After long-term cold exposure, high cold sensation scores were reported, which were negatively correlated with thermogenesis. Skin temperature in the sternal area was tightly correlated with the increase in energy expenditure. CONCLUSIONS: It is concluded that short-term mild cold exposure increases energy expenditure without changes in food intake. Mild cold exposure resulted in significant thermal discomfort, which was negatively correlated with the increase in energy expenditure. Moreover, there is a great between-subject variability in cold response. These data provide further insights on cold exposure as an anti-obesity measure.The study was funded by NIHR, BRC Seed Fund, individual grants: ML and MS: Marie Curie Fellowship, CYT: Welcome Trust Fellowship, SV: MRC, BHF and BBSRC, AVP: BBSRC.This is the final version of the article. It first appeared from Bioscientifica via https://doi.org/ 10.1530/EC-16-000

PNAS plus: plasmodium falciparum responds to amino acid starvation by entering into a hibernatory state

The human malaria parasite Plasmodium falciparum is auxotrophic for most amino acids. Its amino acid needs are met largely through the degradation of host erythrocyte hemoglobin; however the parasite must acquire isoleucine exogenously, because this amino acid is not present in adult human hemoglobin. We report that when isoleucine is withdrawn from the culture medium of intraerythrocytic P. falciparum, the parasite slows its metabolism and progresses through its developmental cycle at a reduced rate. Isoleucine-starved parasites remain viable for 72 h and resume rapid growth upon resupplementation. Protein degradation during starvation is important for maintenance of this hibernatory state. Microarray analysis of starved parasites revealed a 60% decrease in the rate of progression through the normal transcriptional program but no other apparent stress response. Plasmodium parasites do not possess a TOR nutrient-sensing pathway and have only a rudimentary amino acid starvation-sensing eukaryotic initiation factor 2α (eIF2α) stress response. Isoleucine deprivation results in GCN2-mediated phosphorylation of eIF2α, but kinase-knockout clones still are able to hibernate and recover, indicating that this pathway does not directly promote survival during isoleucine starvation. We conclude that P. falciparum, in the absence of canonical eukaryotic nutrient stress-response pathways, can cope with an inconsistent bloodstream amino acid supply by hibernating and waiting for more nutrient to be provided