The Attrition of Democratic Gains in Africa: An Appraisal

Since the reintroduction of multiparty democracy in early 1990s, governments in Africa have established measures and mechanisms to institutionalise and consolidate democracy. International community and local non-governmental organizations have been at the forefront in supporting democratisation initiatives by governments. Despite the efforts, there are structural factors that impede institutionalisation and consolidation of democracy. This paper therefore, seeks to offer a critical analysis of the factors that are contributing to the erosion of democracy. Country examples are highlighted to support the thesis of the paper. The paper uses historical trajectory to demonstrate how patronage, ethnicity, electoral authoritarianism and extension of presidential term limit erodes democratic gains in Africa. The paper concludes that in order for democracy to flourish in African, structural impediments to democracy need to be addressed. Keywords: Democracy, Term Limit, Electoral Authoritarianism, Ethnicity, Electoral Violenc

THE ATTRITION OF DEMOCRATIC GAINS IN AFRICA: AN APPRAISAL

Since the reintroduction of multiparty democracy in early 1990s, governments in Africa have established measures and mechanisms to institutionalize and consolidate democracy. International community and local non-governmental organizations have been in the forefront in supporting initiatives by governments. Despite the efforts, there are structural factors that impede institutionalization and consolidation of democracy. This paper therefore, seeks to offer a critical analysis of the factors that are contributing to the erosion of democracy. Country examples are highlighted to support the thesis of the paper. The paper uses historical trajectory to demonstrate how patronage, ethnicity, electoral authoritarianism and extension of presidential term limit erodes democratic gains in Africa. The paper concludes that in order for democracy to flourish in Africa, the structural factors need to be addressed. Key Words: Democracy, Term Limit, Electoral Authoritarianism, Ethnicity, Electoral Violence 

Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini.

IntroductionUniversal access to antiretroviral therapy (ART) is a cornerstone of Eswatini's national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini.MethodsThe study included structured site assessments at 39 purposively selected health facilities (HF), key informant interviews with 20 HCW, a provider satisfaction survey with 172 HCW and a client satisfaction survey with 270 adults.ResultsAll clients had been on ART for more than a year; 69% were on ART for ≥ 5 years. The most common DART models were Fast-Track (44%), Outreach (26%) and Community ART Groups (20%). HCW and clients appreciated DART, noting that the models often decrease provider workload and client wait time. Clients also reported that DART models helped them to adhere to ART, 96% said they were "very satisfied" with their current model, and 90% said they would recommend their model to others, highlighting convenience, efficiency and cost savings. The majority of HCW (52%) noted that implementation of DART reduced their workload, although some models, such as Outreach, were more labor-intensive. Each model had advantages and disadvantages; for example, clients concerned about stigma and inadvertent disclosure of HIV status were less interested in group models.ConclusionsClients in DART models were very satisfied with their care. HCW were also supportive of the new approach to HIV treatment delivery, noting its advantages to HF, HCW and to clients. Given the heterogeneous needs of people living with HIV, no single DART model will suit every client; a diverse portfolio of DART models is likely the best strategy