Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.
Governance and participation in health
In Zambia, as in other low-income countries, maternal health indicators have remained stubbornly resistant to improvement. This intervention involved revitalizing Safe Motherhood Action Groups to raise awareness of the need to prepare for pregnancy complications and delivery. The main aim was to improve both understanding of maternal health and access to maternal health-care services. The approach was predicated on the assumption that women require not only knowledge about when they should seek skilled help but also their husbands’ approval for care seeking, which can be encouraged by community leaders. The authors adopted a quasi-experimental approach to evaluating the effect of a complex community-based intervention that was devised to reduce barriers to the use of maternal health-care services and to increase deliveries involving a skilled birth attendant. The intervention was novel because it involved the whole community and emphasized social approval and its ability to bring about changes in behaviour. The intervention was associated with significant improvements in women’s knowledge of when they should receive antenatal care and of obstetric dangers signs, in the use of emergency transport, in deliveries involving a skilled birth attendant and in the use of modern contraception. However, the increase in the proportion of women who received four or more antenatal care visits and in those who received postnatal care within 6 days was not significant.
In the area of health, the Southern African Development Community (SADC) has conducted important work in understanding how poor health and poverty coincide, are mutually reinforcing, and socially-structured by gender, age, class, ethnicity and location, demonstrated by the key health policy documents that have been facilitated by the secretariat. Yet the time lapse between the formulation of guidelines and policies and their implementation has at times been uneven. This brief describes the Poverty Reduction and Regional Integration indicator-based monitoring system addressing health priorities for the region, under the institutional leadership of the SADC secretariat and with the support from its Member States that are the main beneficiaries of the process.
This article is an examination and sustained critique of current approaches to communication and information provision within health settings. The authors argue that current practices are based in a one-way model of information transfer that is characterised by a focus on individual behaviour and responsibility, and which is rooted in power relations that are derived from an expert-oriented, unidirectional pattern of speech. They support their criticisms with evidence from a series of qualitative interviews with different populations being addressed, focusing on different subject areas.
In 2007 a group of HIV-positive people in Machaze founded Tchitenderano (‘accord’ in the Ndau language) to campaign against stigma and discrimination in their district, where HIV prevalence is 16.7%, slightly higher than the national average of 16%. So far the group has helped more than 3,000 people. Tchitenderano has 25 activists who hold lectures at various public institutions to educate people about HIV and other sexual and reproductive health issues. They also visit health facilities to encourage patients to adhere to their antiretroviral (ARV) treatment, and provide home-based care. Samuel Doris Campira, president of the organisation, said they were slowly helping to free Machaze district of discrimination and stigma. ‘There were people who would spit at us when they walked by where we were meeting, but today there are families with HIV-positive individuals at home who seek us out to become better informed,’ he said. ‘The stigma is still very strong, despite the legislation and the campaigns,’ he noted, but with time, information and patience, he believed communities would eventually change their attitudes.
In this paper, the authors analyse regional to national-level data flows with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). Special attention is given to pro-poor health policies, those health policies that contribute to the reduction of poverty and inequities. The results demonstrate that health data is shared at various levels. This takes place to a greater extent at the global-country and regional-country levels, and to a lesser extent at the regional-global levels. There is potential for greater interaction between the global and regional levels, considering the expertise and involvement of UNASUR and SADC in health. Information flows between regional and national bodies are limited and the quality and reliability of this data is constrained by individual Member States’ information systems. Having greater access to better data would greatly support Member States’ focus on addressing the social determinants of health and reducing poverty in their countries. This has important implications not only for countries but to inform regional policy development in other areas. By serving as a foundation for building indicator-based monitoring tools, improving health information systems at both regional and national levels can generate better informed policies that address poverty and access to health.
This article evaluates progress in governance of Namibia since independence in 1990. Unemployment is high – estimated at 50% - and pass rates at schools are dropping, while the promised fruits of independence have not yet reached the broad spectrum of the population, and the government’s success in attracting investment has not paid much in terms of long-term dividends. However, there have been plenty of immediate and valuable gains, such as regular elections, much wider access to schooling, and government benefits that are available for ex-combatants and war orphans, and other vulnerable groups. While the courts are at times outspoken, they remain visibly understaffed. Despite the fact that democratic commitment remains fragile in the country, the so-called ‘born-frees’ (those people born after independence) are becoming increasingly vocal and more active in the debate over the country’s future, free speech is now more deeply entrenched and there are a number of vibrant public discussion platforms, including social media.
Civil society organisations in Namibia have called for reforms in the country's public health system after a case of women who were allegedly sterilised without their consent has come to court. According to the coordinator of the AIDS Law Unit of the Legal Assistance Centre, Amon Ngavetene, the redress sought is for reform in the country's health system, and particularly training and supervision of medical staff on the rights of patients.
This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi’s National HIV/AIDS Strategic Framework (NSF). In 2007, researchers conducted a survey to measure perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi’s PRSP process (2000–2004). They also assessed principle health sector and economic indicators and budget allocations for HIV and AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: consensus among global, national, and sub-national actors on goals and measurable outcomes; mutual collective accountability; and enhancement of individual and group health agency. Indicators to assess these elements included: goal alignment; adequate resource levels; agreement on key outcomes and indicators for evaluating those outcomes; meaningful inclusion and participation of groups and institutions; special efforts to ensure participation of vulnerable groups; and effectiveness and efficiency measures. Results suggested that the PRSP process supported accountability for NSF resources. However, the process may have marginalised key stakeholders, potentially undercutting the implementation of HIV and AIDS Action Plans.
This paper examines the changing perceptions of Frelimo's nationalist project amongst members of the middle class in Maputo, Mozambique's capital. The author argues that nationalism in Mozambique has created a system of meaning and new forms of identity that are especially relevant for more privileged urbanites. However, growing urban poverty and inequality has had an effect throughout the social spectrum in Mozambique. and everyday life conflicts with the government's message of unity and progress for all.