African Studies Blog

An interesting Eldis summary of a report on the potential of using mobile phones in improving global health.

This special report on health care and technology, published by The Economist, describes how developing countries are using mobile phones to provides personalised medicine. Drawing from experiences of various countries, the authors demonstrate how new technologies help to tackle the health problems of the world’s poorest.

The authors argue that given their ubiquity, personal convenience and interactivity, mobile phones offer an innovative way to reach reticent HIV sufferers. The authors report on one of the world’s biggest field trial of mobile health technology (or mHealth). Using a form of text messaging similar to SMS, Project Masiluleke in cooperation with MTN, sends out up to a million short messages a day, encouraging the recipients in their local language to contact the South African national AIDS hot line. The authors note that the response has been spectacular, especially among young men who have proved hard to reach in the past.

With demonstrated success in the use of mHealth in the likes of Uganda, Kenya, Rwanda and Mexico, the authors recommend that the visible face of any mHealth or e-health scheme, regardless of where it operates, needs to be as simple and user-friendly as possible, whereas the hidden back end should use sophisticated software and hardware.

The authors conclude that the poor clearly benefit from technical improvements that cut the cost of manufacturing medical devices, make drugs more effective, or eliminate the need for refrigerating vaccines, as well as through big technical breakthroughs that save many millions of lives. Mobile phones, as demonstrated from the examples in this report, can aid early detection, effective early responses, and remote medicine.

Here is a summary from ELDIS of the findings from a  behavioural surveillance study of men who have sex with men in Kigali, Rwanda. The study was conducted in 2008-2009 to describe this population in Kigali, and explore the  nature of sexual activity between MSM. 

Internationally men who have sex with men (MSM) have been identified as a high risk group for HIV acquisition, due to a tendency towards higher risk sexual behaviours and greater numbers of casual (and often commercial) sexual partners. This report from the National AIDS Control Commission Rwanda presents findings from a behavioural surveillance study (BSS) of men who have sex with men in Kigali, Rwanda. Ninety nine questionnaires were carried out which aimed to describe the population of MSM in Kigali and explore the nature of sexual activity between MSM. It was found that MSM in Kigali are at elevated risk for HIV infection compared to the general population, and require specific HIV/STI prevention services/support. The research uncovered a high level of commercial and transactional sex among MSM in Kigali and a high degree of overlap of sexual networks between MSM living in different regions in Rwanda, and perhaps in different countries in East Africa. Approximately one-quarter of respondents reported sex with a woman in the past 12 months. Nearly 40% of these respondents also reported engaging in transactional sex with a woman in the past 12 months.

The authors suggest that further research is urgently needed to assess HIV/other STI prevalence among MSM. They also recommend additional research into MSM sexual networks (i.e. commercial and transactional sex, sex with women, sex and travel). It is recommended that within a sensitive human rights framework, HIV/STI awareness-raising campaigns targeting MSM should be carried out in a method that maximises privacy and safety, and avoids any unintended population-directed stigma and discrimination. The document additionally highlights that health services should be reoriented to ensure that they are MSM-friendly and focused on the specific sexual health needs of MSM. Most urgently, efforts should be made to improve access to sexuality-sensitive psychosocial services, e.g. counselling, for MSM.

Full Report

This comprehensive review by the Population Council  covers topics such as the characteristics of sexual and gender-based violence, characteristics of survivors of sexual violence, medical and psychosocial management of survivors, forensic and judicial aspects of sexual violence and developing institutional and community linkages. Also includes a comphrehensive bibliography on the subject.

Read the full text 

Oxfam an NGO based in the United Kingdom published this report detailing the impact of climate change on livelihoods in Malawi.  The report outlines the ways in which people are adapting to these changes. Here are some of the recommendations:

Recommendations for community level:

• the foundation of any initiative to address climate change hinges on communities being aware of the issues, owning the process of adaptation and having the capacity to undertake and maintain adaptation – there must be wider supportive political and institutional frameworks
• women in Malawi bear the greatest burdens from climate change so it is crucial that their participation is made central to adaptation efforts
• local sustainable environmental and natural resource management are essential in order to reduce vulnerability whether caused by climate change or by environmental degradation – these should be strengthened within adaptation and also Disaster Risk Reduction programmes
• it is important to ensure that initiatives to address climate change are equally integrated with the
  promotion and diversification of sustainable livelihoods.

Recommendations for community-based organisations and NGOs:

• CSOs and INGOs should facilitate awareness and capacity-building around climate change, in their
  staff, their partners, government and other organisations, and in the communities which they serve
• advocacy is required, aimed at the Malawian government, to take it up its role in leadership and coordination, and towards industrialised countries to push for a reduction in their carbon emissions.

Recommendations for government:

• strengthen institutional mechanisms for more effective co-ordination of climate change adaptation and Disaster Risk Reduction programmes – establish budgetary allocations to finance further climate change initiatives. All these efforts must involve poor communities and civil society
• strengthen linkages between the Environmental Affairs department and the Department of Disaster
  Management Affairs – include developing a methodology for harmonised vulnerability and adaptation assessment
• agriculture and related activities should get priority in climate related research – need to strengthen  the capacity of the Meteorological Department to improve both long-term climate modelling and regular, short-term weather forecasting and dissemination in order to give farmers the information that they need

in view of the current round of crucial intergovernmental negotiations towards a post-2012 regime, the government should immediately strengthen its investment in capacity-building its national relegation and diplomatic corps to join with other Southern governments to press for emissions reductions and new mechanisms to ensure flows of new, additional, sufficient and predictable finance for adaptation in poor countries and communities

Read the full text

This article discusses the future for male circumcision as an HIV preventative measure in Africa pointing to a change in strategy for public health officials who are now looking at male circumcision as a key weapon against HIV/AIDS.  Here is an abstract from ELDIS.

Public health officials are now arguing that circumcision of men should be a key weapon in the fight against infection with the human immunodeficiency virus (HIV) in Africa. Recent studies have shown that circumcision reduces infection rates by 50 to 60 percent among heterosexual African men. This article in the New England Journal of Medicine examines the past research and future obstacles associated with introducing circumcision as a preventative measure. The authors discuss the results from previous randomised trials which suggest that circumcision reduced the rate of HIV infection among heterosexual men by 60 percent. Researchers have also found that circumcision provides increased protection against the human papillomavirus, herpes simplex virus, syphilis, and chancroid.

The authors highlight how most people involved in scaling up adult male circumcision recognise that the surgery is a costly endeavour and a socially complex intervention that may compromise other public health priorities. Reaching women through other prevention methods is also important because there is no direct evidence to date that circumcision reduces the risk of transmission from men to women. The article concludes that although circumcision has increasing support from researchers, donors, and politicians, its status as a non–behaviour-based intervention may ultimately be its biggest obstacle. The scale up of circumcision will require strong political backing, adequate funding, and leaders to champion the cause to ensure that it is a safe, low-cost option available throughout Africa.

Read the full text

This book edited by Udesh Pillay, Richard Tomlinson and Orli Bass assesses the development impacts of the 2010 world cup in South Africa focusing on urban impacts and African legacy. Here is an abstract from ELDIS.

The FIFA World Cup is thought to be the biggest sport and media event in the world. It is a hugely profitable event for FIFA through the sale of television rights and sponsorship deals. The same, however, cannot be said of host countries and cities – economic projections are invariably erroneous, overestimating the benefits and understating the costs. In light of the South African government’s intention to leverage the 2010 World Cup to assist in promoting economic development and halving unemployment by 2014, and given the project 30bn Rand South Africa will spend on the event, the debate and uncertain benefits are issues of great consequence. This book describes the build up to the event and assesses the development impacts of the 2010 World Cup, focusing on urban impacts, the debates and probably African legacy.

The significant opportunity for South Africa in hosting the 2010 World Cup lies in contradicting commonly held representations of Africa by utilising the event to project a contemporary, reinvigorated image of Africa, and through celebrating African culture and identity. Moreover, there is potential to destabilise notions of Afro-pessimism through demonstrating that Africans can successfully manage the World Cup.

Previous sporting events in South Africa, most notably the hosting of the 1995 Rugby World Cup and the winning of the 2007 World Cup, have had a cohesive effect on identity and a positive impact on the image of the country. Yet in some ways this remains a transient moment and its legacy is mythical rather than practical. A worsening economic outlook, inflation, rising interest rates, fuel hikes and xenophobic riots have somewhat eclipsed the positive impact of previous events. Notwithstanding these exceptions, opportunity does still exist to mobilise the World Cup in order to tell different, more meaningful and contemporary stories about African life and experience. If a legacy is to be left in this regard, the potential to destabilise common stereotypes and Africa and Afro-pessimism should not be underestimated.

Read the full text

This paper presented by Anthony A Kopoka at the International Conference on Street Children and Street Children’s Health in East Africa, examines Africa’s response to the growing problem of street children. Using Tanzania as a case study the paper examines initiatives that have been and are being taken by various segments of the community to address the problem of street children. It looks at;

• What kinds of policies and strategies are African governments putting in place, what are the families and communities doing?
• How are families, schools and individual members of society dealing with the problems.
• How is the government dealing with the increasing numbers of unsupervised children living alone in urban streets?
• What role can Non-Government Organizations (NG0s) and community based organizations play in addressing the problem of street children?

Read the paper here.

A 2006 report by Human Rights Watch on the situation of street children in the DRC lists these key findings:

• Many street children live in fear of the very state forces charged to protect them. The testimonies from children interviewed revealed a common pattern of routine abuse by police, soldiers, and members of the military police
• The police routinely arrest street children when crimes are committed in areas where they are known to gather. While it is true that street children are sometimes involved in crimes, the police often hold them collectively responsible for crimes or knowledgeable about the events or the perpetrators
• Civilians also exploit street children. They employ children as porters, vendors, cleaners, or labourers in homes and stores, often paying them little money for long hours and physically demanding work
• Two additional and interrelated factors are helping to fuel the increasing numbers of street children: the abuse and abandonment of children accused of sorcery, and the impact of HIV and AIDS on families and children affected by or infected with the virus.

Read the full report here.

From ELDIS:

This comprehensive report to Congress as required by the Trafficking Victims Protection Act of 2000,  addresses 89 countries that were found to have a significant number of trafficking victims.  This may be of use  in researching the trafficking of persons.  Read the abstract.

The report estimates that over the past year at least 700,000, and possibly as many as four million men women and children worldwide were bought, sold, transported and held against their will in slave-like conditions. Women, children and men are trafficked into the international sex trade for the purposes of prostitution, sex tourism and other commercial sexual services and into forced labor situations in sweatshops, construction sites and agricultural settings.

The type of support given by the US government to other countries to combat trafficking includes:

• economic alternative programs for vulnerable groups;
• education programs;
• training for government officials and medical personnel;
• development or improvement of anti-trafficking laws;
• provision of equipment for law enforcement;
• establishment or renovation of shelters, crisis centers, or safe houses for victims;
• support for voluntary and humane return and reintegration assistance for victims;
• and support for psychological, legal, medical and counseling services for victims provided by NGOs, international organizations and governments

Trafficking has reached staggering dimensions around the globe. Solving this problem and bringing relief to its many victims will be possible only through cooperative efforts. This cooperation must occur bilaterally and multilaterally among various governments, but also between governments and civil society, including NGOs.

The report assesses a number of countries that are considered to have a substantial trafficking problem and ranks them according to the concrete efforts taken by their governments to combat the problem.

Full Text

From ELDIS:

This Country Report gives a brief account of the approaches adopted and activities carried out by the various stakeholders, relevant Government and Non-Governmental organisations in the five years since the 2002 Second World Assembly on Ageing in Madrid and the adoption of the Madrid International Plan of Action on Ageing (MIPAA).

The report describes various policies that the Ghanaian government have implemented to take care of the issue of the aged, including the National Social Protection Strategy 2006, Ghana National Disability Policy and National Health Insurance Scheme (NHIS). The report also describes the Draft Policy on Ageing.  The main goal of the Draft Policy is to promote the social, economic and cultural re-integration of older persons into mainstream society, to enable them participate fully and as far as practicable in national development and social life, while recognising their fundamental rights.

Some of the strategies of the draft policy on ageing include:

• creating a National Co-ordinating Institution on Ageing
• providing comprehensive health care programmes including professional age carers for older persons at both national and community levels
• promoting employment of older persons
• promoting community care facilities such as day care centres for older persons

The report looks at the demographic and socio-economic profile of ageing in Ghana, and goes on to describe the range of programmes that have been implemented to assist the elderly.

The report concludes that :

Whilst Ghana has made modest progress in the implementation of the Madrid International Plan of Action on Ageing, there are some challenges that should be addressed. These challenges include:

• the need to finalise the policy on aging and develop appropriate action plans for its implementation
• the need to strengthen and resource the Ministry of Manpower Youth and Employment (MMYE) and other institutions to effectively co-ordinate the implementation of the MIPAA
• modernisation is impacting both positively and negatively on traditional values. There is the need to project the positive elements of modernisation to benefit the aged

Full Text Document