Publications

This paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacity building intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda

The aim of the present study is to assess the cost–effectiveness of community-based practitioner programmes with different design features across three countries – Ethiopia, Indonesia and Kenya – in which these initiatives have been implemented to scale.

Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals across Europe and offers further insight into the evidence base for R&R; the interaction between policy and organisational levels in driving R&R outcomes; the facilitators and barriers throughout these process; and good practices in the R&R of health professionals across Europe. The study adopted a multi-method approach combining an extensive literature review and multiple-case study research. 64 publications were included in the review and 34 R&R interventions from 20 European countries were included in the multiple-case study. We found a consistent lack of evidence about the effectiveness of R&R interventions. Most interventions are not explicitly part of a coherent package of measures but they tend to involve multiple actors from policy and organisational levels, sometimes in complex configurations. A list of good practices for R&R interventions was identified, including context-sensitivity when implementing and transferring interventions to different organisations and countries. While single R&R interventions on their own have little impact, bundles of interventions are more effective. Interventions backed by political and executive commitment benefit from a strong support base and involvement of relevant stakeholders.

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20 % of community health workers’ (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80 % on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs.

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in lowand middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review.

Sudan has high maternal mortality. The rate among nomads – groups of people who move from place to place as a way of obtaining food, finding pasture or make a living – is very high and varies between different regions of the country. The objective of the study is to identify the factors affecting the utilization of maternal health care services by nomadic communities in Sudan, to make recommendations to improve their health. Nomadic health practices and health care services are the main influencing factors affecting the utilization of maternal health care services. Nomadic health practices are influenced by the mobile lifestyle of nomads, their low level of education and knowledge, gender norms, beliefs, values and attitudes, and their geographical locations. Existing health care services are ill-adapted to the nomadic lifestyle. The study also demonstrates some best practices from other countries that can be applied to the nomadic context in Sudan, such as community health workers, training and support for traditional birth attendants, provision of joint mobile health services for humans and livestock and the establishment of maternity or birth waiting homes. Since the utilization of maternal health care services by nomads is extremely low, the study recommends evidence-based strategies to increase community demand for services or bring women closer to emergency obstetric services.

The Democratic Republic of the Congo is one of the countries in Sub-Saharan Africa with the highest maternal mortality ratio estimated at 846 deaths per 100,000 live births. Innovative strategies such as social accountability are needed to improve both health service delivery and utilization. Indeed, social accountability is a form of citizen engagement defined as the ‘extent and capability of citizens to hold politicians, policy makers and providers accountable and make them responsive to their needs.’ This study explores existing social accountability mechanisms through which women’s concerns are expressed and responded to by health providers in local settings.

Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services.

This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

The Hausas are the largest ethnic group in Northern Nigeria. Traditionally, Hausaland was divided into kingdoms, which were ruled by a Sarki (king or chief) (Wall, 1988). Within Hausaland, a hierarchy of different officials was present, with titles such as SarkinKasuwa (Chief of the market) or SarkinMakafi (Chief of the blind) (Onwuejeogwu, 1999). The emir of the state controls all the Sarakuna (plural of Sarki). Today, the hierarchy of traditional leaders still exists in Northern Nigeria and is influential at the local government level, especially when religious or security matters are at stake (Miles, 1987). It is however unclearwhat influence traditional leaders have on the socio-economic position of persons with disabilities.

Skin diseases are common and cause considerable morbidity worldwide. Lack of awareness of symptoms among the majority of lay people^1,2 and lack of knowledge about skin diseases among first- and second-line health care providers have contributed to underestimations.³ Household surveys (including people not seeking treatment) before 2000 report point prevalence rates of 27%–53%,^2,4,5 while it was 62%–87%^6,7 after 2000. This increase may be due to the rising industrialization in developing countries, or different definitions of skin diseases as suggested by Abdel-Hafez et al.⁶ In Sub-Saharan Africa, population-based studies in primary schools report point prevalence rates of 27% and 74%.^8–11 Community-based studies by Mahé et al¹² and Odueko et al¹³ report that respectively 11.7% and 9.8% of the patients consulted primary health centers with skin-related symptoms.

CATALIST-Uganda aims to sustainably commercialize smallholder agriculture through improved productivity and market development. Marketable surpluses resulting from the programme will both raise farm incomes in Uganda, and increase regional food security for the wider East Africa and Great Lakes Region. The four-year CATALIST-Uganda project is funded by the Netherlands Ministry of Foreign Affairs through the Embassy of the Kingdom of the Netherlands (EKN) and began on July 1, 2012

The Educational Sector Development Programme (ESDP) IV has set objectives to strengthen the representation and leadership of women academics in universities. It aims to have by 2015 20% of academic staff to be women and 16 females in top academic positions (university (vice-) president). Affirmative action and women’s rights are also enshrined in the Ethiopian Constitution. Women have indeed entered the universities over the past decades; progress on gender balance in academic positions and university management is however below target. This assessment looks
at the actual status in 13 universities, and identifies challenges of female faculty.

The women’s movement in Zimbabwe has gone through highs and lows in its long history of mobilizing at different levels and on various issues. The first years of the 2000s were such ‘low’ ones that many afterwards wondered whether the women’s movement still existed. Yet new initiatives have emerged and grown, and contexts are changing. New generations and new modes of organizing and agency have taken shape, and significant successes in legal reform have taken place. This paper thus reframes the question about the status of the Zimbabwean’s women’s movement and explores how it is reconfiguring itself and continuing to exist. We first document recent methods of organizing and mobilizing by women in Zimbabwe and look both at new players and new forms of action. Secondly,
we seek to document the movement’s achievements and challenges since the turn of the millennium. The focus will be on organizing through women’s NGOs. The women’s movement in Zimbabwe comprises many actors, key among them women’s NGOs and clubs; women in political parties and the labour movement; women’s religious associations and women’s professional or business associations. In this paper, however, the women’s movement refers to organizing through women’s NGOs. In documenting new players and new forms of action, as well as identifying challenges and achievements, the paper seeks to reflect on and rethink the women’s movement and its status in the contemporary Zimbabwean context. This also provides a basis for reflection on strategies for
transformative change and their underlying theories of change, and on how women’s organizing engages with the state in the pursuit of gender equality and women’s rights.

This study explores how gender matters in small-scale farm power mechanization in African agriculture, particularly in maize-based systems. It investigates how intra-household gender dynamics affect women’s articulation of demand for and adoption of mechanization in Ethiopia and Kenya. The study offers a conceptual approach to grasp these gender dynamics, a gender analysis methodology, and a set of recommendations. The central research question is: How do intra-household gender dynamics affect women’s articulation of demand for and adoption of mechanization?

Sexual and Reproductive Health (SRH) is a major focus area in South Sudan’s national health policy; the Reproductive Health Strategic Plan (2013-2016) has identified family planning as a key strategy for achieving the nation’s reproductive and public health goals. The strategy includes the launch of a national health and family life education campaign, initiatives to help couples make informed choices, and explicitly to encourage the involvement of men in the process.

Sexual and Reproductive Health (SRH) is a major focus area in South Sudan’s national health policy; the Reproductive Health Strategic Plan (2013-2016) has identified the improvement of access to and utilization of health facilities by all individuals as a key strategy for achieving the nation’s reproductive and public health goals. The strategy focuses on increasing access to and utilization of antenatal care, postnatal care and facility/skilled deliveries .

This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.