The impact of contextual fragility on development in practice: perspectives from Zimbabwe

This article explores the impact of contextual fragility on development in practice in the context of partnership working. The utilization of oppressive legislation and stringent registration for CSOs by a state fearful of losing political hegemony resulted in limited community participation and CBO reluctance to engage in advocacy activities deemed political despite northern partner eagerness. Financial distress led to a partnership termination, partial and non-implementation of some development activities. Utilizing contextual analysis to unmask the heterogeneous nature of fragile contexts can be a valuable starting point in capturing unique complexities and irregularities in each context to inform program planning

The impact of international non-governmental organisations on the response of community-based organisations to the HIV/AIDs related orphan and vulnerable children crisis in Zimbabwe: the case of Batsiranai and Danish Association for international cooperation in Manicaland

This thesis explores the relationship between an international non-governmental organisation (INGO) and a community based organisation (CBO) addressing the HIV/AIDs- related orphan and vulnerable children (OVC) crisis in Zimbabwe. The study engages with how INGOs have emerged as key conduits for development aid, rather than African governments against a backdrop of development strategies being dominated by northern perspectives at the expense of southern knowledge and cultures. However, there is a convergence of global policy view that at the local level, families and community initiatives and CBOs are crucial to addressing the OVC development agenda. In view of this, some critics have questioned the capacity of African families and even the very existence of communities. In spite of the considerable debates about INGOs' role in funding CBOs, this thesis is based on the assumption that external funding will be necessary for the foreseeable future. Against this background, this thesis aims to unravel assumptions and debates about communities and INGOs. Central is the question what partnership between INGOs and CBOs would entail, whether it is desirable and if so, how it can be promoted. The case study of Batsiranai, a CBO based in rural Zimbabwe and the Danish Association for International Cooperation in Manicaland (MS), the INGO which partly funds its work, is used to address this question. The thesis draws on field work done in Zimbabwe and UK employing in-depth interviews, focus group discussions, participant observation, and documentary analysis. Research participants were selected to include six Batsiranai and two MS staff, seven key informants, HIV-affected six children, and fourteen volunteers. The study shows the existence of a community as experienced by some residents of Buhera South District and OVC problem ownership in spite of the challenges. Volunteers are the bedrock of Batsiranai's response motivated by traditional cultural capital which operates as a system of solidarity. However, the concepts of "volunteer" and "volunteering" emerged as problematic due to the specific cultural ensemble prevalent in Buhera South District, which places "volunteering" in collectively structured obligations where individual choice is significantly constrained and shaped by the promptings of other community members. Most crucially this study shows that volunteers are poor people bearing the cost of real participation, in a context lacking a welfare system for the poor. Hence the call for an acceptable token. While children receive various forms of support such as food and school fees Batsiranai has a full agenda without meeting their psycho-social needs. Psychosocial support appears a "soft" area of development due to limited resource allocation. Findings show that partnership between an INGO and CBO is partially possible when power inequalities are honestly acknowledged and recognized as chronically problematic. It is apparent that Batsiranai, despite enormous pressures, is operating as the key front line provider of support and distributor of resources. MS is unusually flexible in comparison with most INGOs in its approach to development and was therefore able to go some way to implementing aspects of partnership: the lines of hierarchy were consequently flatter and links amongst stakeholders were simpler than would be the case with major INGOs. The analysis and experience of partnership between MS and Batsiranai shows that it is a resource demanding process, which requires a long period of time to produce desirable outcomes. However, to great extent, the contextual environment currently prevailing in Zimbabwe played against the partnership. Nhimbe emerges in this study as a traditional cultural resource which can be harnessed for INGOs and CBOs partnerships on OVC in Zimbabwe as a starting point to remedying the scarcity of southern knowledge and cultures in development. In establishing an INGO and CBO partnership on OVC, the former needs to be flexible from the onset and prioritize the latter's institutional development, harness traditional cultural capital and listen to children's voices. Volunteers' should be given an acceptable token, and receive due recognition of their contributions. The state should create an enabling policy environment for OVC partnerships. Future OVC INGO- CBO partnerships in Zimbabwe are encouraged to harness Nhimbe as a way of creating a fusion, between northern and southern perspectives that is culturally and context appropriate. Future studies need to further explore the applicability of the concept of "volunteering" and how participation costs can be mitigated, while preserving a community's resilience. Batsiranai's dependency on external resources calls for an exploration on how Zimbabwean Diaspora communities' resources can be tapped within the context of development aid. Nhimbe remains a subject open to further research

Remote fieldwork with African migrant women during COVID-19 pandemic in London: a reflection

As coronavirus disease 2019 (COVID-19) pandemic unraveled, state-led preventative restrictions created a "new" normal through remote home-working. A long-planned follow-up qualitative research study on risk perceptions and experiences regarding Clay Ingestion among black African women during pregnancy, in London, was disrupted as England went into lockdown. Against this backdrop, we shifted to remote data collection which raised pertinent concerns around access to technology and participant digital skills. We share our experiences of navigating through remote fieldwork during the pandemic with black African mothers with caring responsibilities as well as the extra burden of homeschooling, the challenges we encountered and how we mitigate these and the lessons learnt. Thus, drawing from our remote qualitative research experiences, we refer to notable examples of challenges, mitigating strategies applied and potential lessons to inform future practice

Experiences of geophagy during pregnancy among African migrant women in London: implications for public health interventions

This study explored African migrant women's clay ingestion experiences during pregnancy against a backdrop of health risks warnings in order, to inform public health interventions by the UK Food Standards Agency and Public Health England, now known as the UK Health Security Agency. An interpretative phenomenological approach (IPA) was utilized, and data were collected with a total of 30 participants through individual in-depth interviews and one focus group discussion. Findings showed clay ingestion is a fluid and widely accepted cultural practice among African communities with most participants having been socialized into ingestion during childhood, through family influences and current social networks in their adulthood. Vomiting, nausea, spitting, appetite challenges, and cravings were cited as the main reasons for clay ingestion during pregnancy. With strong claims regarding its effectiveness, clay was ingested every day by most participants, and at times in large quantities despite the potential health risks. This calls for innovative and culturally sensitive public health interventions starting with the inclusion of clay ingestion health risk messages in maternal health nutrition information within antenatal settings. This can be done as part of multilevel interventions informed by life course approaches, which also consider community health messages and an enabling regulatory policy framework focusing on clay sold for human ingestion

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

The impact of international non-govermental organisations on the response of community-based organisations to the HIV/AIDs related orphan and vulnerable children crisis in Zimbabwe : The cse of Batsiranai adn Danish Association for international cooperatio

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Clay ingestion during pregnancy among black African women in a North London Borough: understanding cultural meanings, integrating indigenous and biomedical knowledge systems

Findings from this qualitative audit conducted in a North London Borough among Black African women show that clay ingestion during pregnancy is a cultural phenomenon embedded in indigenous knowledge (IK). Reasons for clay ingestion include curbing morning sickness, nausea, satisfying cravings, “mineral deficiency” and other life sustaining beliefs. However, Public Health practitioners' top down approach and response which considers the practice as “dangerous” and potentially harmful to the health of the woman and unborn child with midwives and General Practitioner doctors called upon to discourage it, risks alienating the target population. Furthermore, within such a top down framework, opportunities to integrate biomedical science and indigenous knowledge systems are potentially missed. The use of culturally sensitive Public health interventions which consider a community approach, while attempting to integrate these two knowledge systems through further research is likely to bear more fruits

Late booking amongst African women in a London borough, England: implications for health promotion

The National Institute for Health and Clinical Excellence guidance is that a pregnant woman should see a midwife within the first 13 weeks into her pregnancy, in what is known as the ‘booking appointment’ or the ‘full assessment’ where she discusses with the midwife her care plan, medical and family histories and social circumstances. Significant numbers of black African women present after 13 weeks into the pregnancy. This study explores why black African women access the booking appointment after 13 weeks of pregnancy in a London borough. The study took a qualitative approach and used semi-structured interviews with 23 women who self-identified as black African migrants born in a sub-Saharan African country, and had experience of using ante-natal services in the borough. Participants discussed how their cultural understandings of pregnancy influenced timing of the booking appointment. The data was analysed using the thematic approach. Cultural, economic and political contexts within which they experienced pregnancy influenced the timing. Whilst acknowledging the benefits of early booking, this was said to be at odds with their cultural beliefs where pregnancy disclosure within 13 weeks was considered inappropriate. Lack of information about the booking appointment and unresolved immigration issues led to perceptions that they were being brought under the Immigration Department’s radar through the booking appointment. Whilst most health promotion information regarding the booking appointment is designed in a top-down fashion, health planners should also recognize ethnic diversities so as to market the booking appointment using downstream approaches that take account of the cultural, political and economic contexts in which migrants/ethnic minority populations live

‘This word volunteer is killing us’: Making sense of volunteering in social welfare provision for orphans and vulnerable children in rural Zimbabwe

This qualitative study explored how volunteers delivering social welfare to orphans and vulnerable children through a community initiative supported by donors made sense of volunteering during a period of hyperinflation in Zimbabwe. Findings confirm that volunteering in Africa is influenced by a normative value system embedded in Ubuntu. Volunteering emerged as contradictory given the contextual prevalence of the social obligation discourse rather than individual choice as embedded in the European sense of voluntarism. Volunteering masked the cost of participation, thereby potentially making poverty worse for the poor in a context without a formal welfare system

African migrant women acquisition of clay for ingestion during pregnancy in London: a call for action

Objectives: This study aimed to explore how African migrant women go about acquiring clay for ingestion during pregnancy in London against a backdrop of restrictions and warnings by the Food Standard Agency and Public Health England due to the potential health risks to expectant mothers and their unborn babies. Study design: This was a qualitative study using an interpretative phenomenological approach. Methods: Individual in-depth interviews and a focus group discussion were used for data collection. Data collection took place between May and August 2020. Results: Participants acquired clay from African shops and markets in London, countries of origin and online/social media platforms. Due to official restrictions and warnings, transactions were conducted under the counter based on trust between sellers and the women underpinned by shared community identities. However, clay was acquired, social networks emerged as crucial facilitators. The current top down approach, which is also lacking a regulatory policy framework, has pushed clay transactions underground, thereby leaving pregnant women potentially ingesting toxic clay with little chances of dictation by authorities. Conclusion: We call on the UK Health Security Agency (UKHSA) and public health practitioners to collaborate with communities to design multilevel/multisectoral interventions as well as the Food Standards Agency (FSA) to consider an appropriate regulatory policy framework