A global discussion regarding how to renew the Millennium Development Goals (MDGs) is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities. This qualitative study used focus group discussions and key informant interviews with older people in Uganda’s Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings. Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available.
Poverty and health
This document is the second of a series addressing issues surrounding poverty and poverty reduction. It explains perceptions of poverty of the poor, well off and development practitioners to give a more complete picture of poverty. The briefing emphasises the need for poor people’s involvement in defining and exploring multiple dimensions of poverty. This points out the drawbacks of relying on understanding and interpretations of researchers and development practitioners. Providing examples from previous studies in Tanzania, Ghana, Bangladesh, India and Pakistan, the document admits that understanding of poverty varied greatly. Therefore the process of arriving at a shared understanding of poverty can be challenging but important.
Both maternal HIV diagnosis and household food insecurity may increase maternal stress levels, and lead to unhealthy coping behaviours. In this study, researchers examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress. For 12 months after childbirth, they followed 232 Ghanaian women recruited prenatally from hospitals offering voluntary counselling and testing (VCT). They found that the proportion of HIV-positive women who lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection and persistent household food insecurity were independently associated with high stress. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for high maternal perceived stress. Comprehensive multidimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in sub-Saharan Africa.
The One Million Campaign report that babies below 3 years were fed milk powder contaminated with melamine, an industrial chemical used in fertilisers and plastic production. If they had been fed on their mother’s milk, they could have been saved from this unnecessary catastrophe. The One Million Campaign seeks signatories to support women to breastfeed and stop the push towards feeding babies with milk formula.
What would a city free from poverty really look like for urban youth in Tanzania? Dr Nicola Banks, ESRC Future Research Leader, in this video presented information from local research on young people’s vision for a poverty-free city in Tanzania. The video reports evidence from participatory discussion with youth. Urban youth make up a huge proportion of city populations- and the video highlights the economic and social opportunities Tanzanian youth raised in their discussions.
A package of policies is required to deal with the multi-faceted nature of barriers to health care in developing countries, according to a paper from the Centre for Health Policy's School of Public Health, at the University of the Witwaterstrand, South Africa. This package would have higher levels of taxation of higher income groups, insurance in proportion to income and would allow greater cross-subsidisation across groups, with exemption schemes and low or no user fees. Increasing health expenditure is another important means of increasing provision for the poor, but the impact of any increase will depend on how resources are allocated. The paper says most developing countries aim for universal access to health but in reality, health systems are often ineffective at reaching the poor, as the poor face greater cost-related barriers to accessing health care.
This paper reviews a set of key health policies and examines the factors that influence their effectiveness.
South Africa's high child mortality rates have forced the government to rethink its policy on infant feeding and move to discontinue the free provision of formula milk at hospitals and clinics, as well as promote an exclusive breastfeeding strategy for all mothers, including those living with HIV. Minister of Health Aaron Motsoaledi made the announcement on 23 August 2011 after a two-day national consultation on breastfeeding, where participants unanimously recommended the changes. Until now, the country's health system has not supported the practice of breastfeeding and mothers are often discharged as soon as six hours after birth, with no or little counselling on infant feeding, the Minister of Health acknowledged. Formula milk manufacturers and distributors have also promoted their products aggressively, because of the absence of legislation to regulate the marketing of formula milk, according to UNICEF. In December 2009, the UN World Health Organisation (WHO) issued guidelines recommending that infants born to HIV-positive women be exclusively breastfed for the first six months, but South Africa's programme to prevent mother to child HIV transmission has continued to provide free formula to HIV-positive mothers. Representatives of WHO in South Africa are calling on government to implement the guidelines.
The free basic water policy is being unevenly implemented and greater attention needs to be given to meeting the needs of the rural poor and those in poor peri-urban communities who would most benefit from its provision, concludes an HSRC report which examines the extent to which the response to the cholera epidemic of 2000/1 has led to sustained provision of safe water and improved sanitation to the poor. The original report suggests there is a clear relationship between cost recovery, indifferent municipal management leading to interruptions in supply, and vandalism.
In this media briefing, Oxfam reveals that investors are targeting the world’s weakest-governed countries to buy land, and it calls on the World Bank to lead the fight against land grabs. It argues that the Bank is in a unique position to act because it sets international standards for land investments, provides finance for land deals and advises developing countries on land investments. Oxfam’s analysis reveals that over three quarters of the 56 countries where land deals were agreed between 2000 and 2011 scored below average on four key governance indicators. The 23 least developed countries account for more than half of the recorded land deals over this period. Researchers assessed a range of factors including voice and accountability (e.g. whether citizens participate in selecting their government), rule of law, the quality of private sector regulation, and control of corruption. They found poor governance is good business for investors looking to secure land quickly and cheaply. Investors seem to be cherry-picking countries with weak rules and regulations. This can spell disaster for communities if these deals result in their homes and livelihoods being snatched away without consent or compensation.
This paper describes patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and develops a theoretical framework to analyse the determinants of child malnutrition and ill-health, and identify the different mechanisms which contribute to these outcomes in such children.
It is based on statistical analysis of data on 31 672 children aged 0–17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill-health seen in OVC.