Publications

The recent thematic series on close-to-community providers published in this journal brings together 14 papers from a variety of contexts and that use a range of research methods. The series clearly illustrates the renewed emphasis and excitement about the potential of close-to-community (CTC) providers in realising universal health coverage and supporting the sustainable development goals. This editorial discusses key themes that have emerged from this rich and varied set of papers and reflect on the implications for evidence-based programming. We are at a critical stage in the development of CTC programming and policy which requires the creation and communication of new knowledge to ensure the safety, sustainability, quality and accessibility of services, and their links with both the broader health system and the communities that CTCs serve.

The aim of combination antiretroviral therapy (cART) is to suppress plasma human immunodeficiency virus (HIV) viral load (VL) to undetectable levels. The usual median time to achieve full viral suppression is about 100 days. Most HIV patients, both in high-income and in resource-poor countries, also display an immunological response to treatment, measured as an increase in CD4 count. In 14–25% of patients CD4 count does not rise substantially
despite successful viral suppression. This phenomenon has been referred to as an immunological discordant treatment response

In recent years, social protection has climbed up the policy agenda as a major policy response to chronic poverty and vulnerability with positive impacts on food security, income and access to basic services. In SubSaharan Africa, persistent levels of poverty and inequality, unemployment and underemployment, and a high degree of labour market informality have encouraged governments to adopt social protection as a key instrument for achieving inclusive development (Miroro, 2015). Its ability to achieve inclusive development is largely due to its catalytic role in redistribution and potential to reach the poorest (Ministry of Foreign Affairs, 2015; Olivier, 2013). Inclusive development here is defined as a ‘pattern and pace in which the poor and most vulnerable groups participate and which is characterised by income growth, increase of productive employment as well as decreasing inequality in both income and non-income dimensions of wellbeing’ (NWO, 2014).

YES I DO. is a strategic alliance of five Dutch-based organizations which main aim is to enhance the decision making space of young people about if, when and whom to marry as well as if, when and with whom to have children.

The evaluation provided an independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The results of the evaluation have informed the midterm review of the UNFPA 2014-2017 Strategic Plan.

Tuberculosis (TB) is a global health problem. In 2014, an estimated 9.6 million people developed TB and 1.5 million died from the disease Currently, 22 high burden countries account for over 80% of world’s TB cases. Notification data in these countries often do not reflect the actual number of cases in the country due to incomplete coverage and absence of appropriate surveillance systems. Thus, direct measurement of the burden of disease through TB prevalence surveys remains key for understanding the spread and extent of the disease and aid in developing appropriate control measures in these settings

What does empowerment of women and girls mean? The White Paper that was developed as the first component of this project sought to address this question. A conceptual model on empowerment of women and girls was developed in close partnership with the Bill and Melinda Gates Foundation. The model aims to provide conceptual clarity and a common language on what empowerment of women and girls means for the foundation. The White Paper defines empowerment of women and girls as ‘the expansion of choice and strengthening of voice through the transformation of power relations, so women and girls have more control over their lives and futures. It is both a process and an outcome’.

Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues.

Exploring new ways of improving sexual health and wellbeing of young MSM in Bangladesh through a Motivational Intervention (MI+) approach

KIT Royal Tropical Institute was commissioned by Solidaridad, in partnership with Marks & Spencer, to understand the unmet needs of cocoa growing communities in Ghana, ideate new SME service concepts and develop high-level business models. The study was to also provide Solidaridad with a roadmap to foster SME development.

Evaluation is seen as vital for both accountability and learning purposes. This involves understanding not only what worked but also the process of change and why and how an intervention worked. Donors, programme managers and evaluators often claim to seek not only successful outcomes, but the ‘holy grail’ of impact. This paper surveys the minefield of what impact is and how it can be reliably assessed, from the perspectives of proponents favouring (quasi)experimental, quantitative designs to those oriented towards the qualitative.

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.

Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media.

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?

Value chain development approaches seldom deliver large scale impact. Based on the examination of five cases where impact at scale was realised, recommendations are offered to increase the chances of value chain interventions contributing to impact at scale.

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.

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 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.