Global health research, partnership, and equity: no more business-as-usual

The papers in this important collection reflect a mature and confident way of doing global health research which is anything but business-as-usual. In the context of increasing competition for individual or institutional “leadership” of the field (and business) of gobal health, these contributors instead speak of active and sustained collaboration -- listening, responsiveness, flexibility, willingness and capacity to follow as well as to lead -- in learning what to transform or sustain, and how, in order to move towards greater equity in both health and health research. Each paper and the collection as a whole is an important contribution to the evidence base for a range of issues from maternal health, HIV and access to services, to chronic disease, health system strengthening, occupational health, ecosystemic approaches to health, and social inclusion, exclusion, and neglect. In addition, they challenge conventional models of research focused on narrowly defined research questions and a narrow range of pre-specified research methods, documenting instead how both the research questions and the methods most appropriate to address them change over time. Finally, they challenge both the idea of “pure” science undertaken by independent researchers on behalf of science and specific communities, and the conventional wisdom that North-South and research-research user-community partnerships are necessarily either North and researcher-driven, or scientifically dubious.Web of Scienc

Human trafficking and human rights violations in South Africa: Stakeholders' perceptions and the critical role of legislation

This article examines the perspectives of governmental and nongovernmental stakeholders in South Africa on the dynamics of human trafficking in South Africa, and on efforts to protect the human rights of rescued victims of human trafficking prior to the promulgation of human trafficking legislation in the country. The authors seek to understand the range of views and approaches of stakeholders to trafficking, including possible links to HIV, as human trafficking is commonly discussed in the media, but empirical research on the scale, dynamics, and impacts of trafficking in South Africa is scarce. This exploratory situation analysis involves desk review and 24 key informant interviews, using purposive and sequential referral sampling. Respondents included government departments and non-governmental organisations working at a border-crossing site (Musina), and two major destination sites for irregular migrants, including trafficked people (Johannesburg and Cape Town). Almost all respondents reported that human trafficking is significant and complex, and that both cross-border and internal movement of trafficked victims violate victims' rights in several ways. While they suffer at the hands of organised crime syndicates, their rights are further violated even after rescue, prior to the recently-promulgated human trafficking legislation in the country. Victims' access to justice is also either delayed or denied in many cases due to the inability to prosecute the perpetrators. The study concludes that, despite the recent giant step in the right direction in promulgating human trafficking legislation in South Africa, there is a need for further efforts by the South African government to take additional proactive and practical measures for optimum effectiveness of the law without which the goal of the Act may remain a tall dream.International Bibliography of the Social Science

Street children, human trafficking and human security in Nigeria:competing discourses of vulnerability and danger

This paper examines the lived experience of street children and other stakeholders’ perceptions in three urban cities (Lagos, Kaduna and Port Harcourt) in Nigeria. The study used quantitative and qualitative methods to explore the perspectives of five major stakeholders: Government Agencies, Civil Society Organizations, the Community, Non-Governmental Organizations (NGOs) and street children themselves. The findings revealed that street children are perceived to be perpetrators as well as victims of crime. They are exploited, abused and used as drug mules, pressed into commercial sex, and manipulated or bribed into the fire-bombings and violence in Nigeria. While some stakeholders urge increased protection of child rights, others canvassed for “eradication” of the street children. There is therefore the need for more pragmatic steps by the Nigerian government and civil society to address the conditions faced by street children in order to address the security problems and the fundamental human rights of the children

Knowledge management

French version available in IDRC Digital Library: Bulletin research matters, avril 2007Research Matters (RM) supports the effective exchange and translation of sound and innovative research among a wide range of research-users. The newsletter is published on a biannual basis and contains updates about RM’s projects, activities and products, with a specific focus on a topic that is of interest to members and partners. This issue concentrates on Knowledge Management and desktop software

Gestion des connaissances

Version anglaise disponible dans la Bibliothèque numérique du CRDI : Research matters newsletter, April 200

Balancing the personal, local, institutional, and global: multiple case study and multidimensional scaling analysis of African experiences in addressing complexity and political economy in health research capacity strengthening

Background Strengthening health research capacity in low- and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa. Methods We reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work. Results Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalization of knowledge and the linked mobility of (elite) individuals, and institutionalization of research within universities and research centres and, increasingly, national research and development agendas. Conclusions We identify tensions between efforts to embrace the global 'Community of Science' and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers.sch_iih13pub4234pub

Balancing the personal, local, institutional, and global: multiple case study and multidimensional scaling analysis of African experiences...

Background Strengthening health research capacity in low- and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa. Methods We reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work. Results Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalization of knowledge and the linked mobility of (elite) individuals, and institutionalization of research within universities and research centres and, increasingly, national research and development agendas. Conclusions We identify tensions between efforts to embrace the global ‘Community of Science’ and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers. Keywords Capacity strengthening Complexity Global health research Globalization Institutional capacity North-South-South partnerships Political economy of health research Mentorshi

High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe

Introduction: Intimate partner violence (IPV) is a common formof violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. Methods: Data were collected from 842 women interviewed postnatally in six postnatal clinics in Harare, Zimbabwe. We used the World Health Organization versions of IPV and Centre for Epidemiological Studies — Depression Scalemeasures to assess IPV and PND respectively.We derived a violence severity variable and combined forms of IPV variables from IPV questions. Logistic regression was used to analyse data whilst controlling for past mental health and IPV experiences. Results: One in five women [21.4% (95% CI 18.6–24.2)] met the diagnostic criteria for PND symptomatology whilst 21.6% (95% CI 18.8–24.4) reported postpartum suicide thoughts and 4% (95% CI 2.7–5.4) reported suicide attempts. Two thirds (65.4%) reported any form of IPV. Although individual forms of severe IPV were associated with PND, stronger associations were found between PND and severe emotional IPV or severe combined forms of IPV. Suicidal ideation was associated with emotional IPV. Other forms of IPV, except when combined with emotional IPV, were not individually associated with suicidal ideation. Conclusion: Emotional IPV during pregnancy negatively affects women’s mental health in the postnatal period. Clinicians and researchers should include it in their conceptualisation of violence and health. Further research must look at possible indirect relationships between sexual and physical IPV on mental health

“That pregnancy can bring noise into the family”: exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe

Background: Globally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women’s and health workers’ perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing. Methods: This qualitative study was part of a larger study of the dynamics of intimate partner violence and HIV in pregnancy in Zimbabwe. Key informant interviews were conducted with health workers and focus group discussions were held with 64 pregnant or nursing mothers attending antenatal and postnatal care clinics in low-income neighbourhoods of Harare, covering the major thematic areas of validated sexual violence research instruments. Thematic content analysis of audio-recorded and transcribed data was conducted. Results: While women reported some positive experiences of sex in pregnancy, most participants commonly experienced coercive sexual practices. They reported that men failed to understand, or refused to accept, pregnancy and its associated emotional changes, and often forced painful and degrading sexual acts on them, usually while the men were under the influence of alcohol or illicit drugs. Men often refused or delayed HIV testing, and participants reported accounts of HIVpositive men not disclosing their status to their partners and deliberately infecting or attempting to infect them. Women’s passive acceptance of sexual violence was influenced by advice they received from other females to subordinate to their partners and to not deprive men of their conjugal sexual rights. Conclusions: Cultural and societal factors, unequal gender norms and practices, women’s economic vulnerability, and men’s failure to understand pregnancy and emotional changes, influence men to perpetrate IPSV, leading to high risk of HIV infection