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Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Learning from doing the EquitAble project: Content, context, process, and impact of a multi-country research project on vulnerable populations in Africa

MACLACHLAN, Mac
AMIN, Mutamad
MJI, Gubela
MANNAN, Hasheem
MCVEIGH, Joanne
MCAULIFFE, Eilish
AMADHILA, Elina
MUNTHALI, Alister
EIDE, Arne H
DUBE, A Kudakwashe
2014

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Background: The ‘EquitAble’ project carried out content analyses of policies and collected and analysed qualitative and quantitative data concerning access to health services in Sudan, Malawi, Namibia and South Africa. Our particular concern was to address the situation of people with disabilities, although not in isolation from other marginalised or vulnerable groups.

 

Objectives: This article reports on the content, context, process and impact of project EquitAble, funded by the European Commission Seventh Research Framework Programme, which brought together researchers from Ireland, Norway, South Africa, Namibia, Sudan and Malawi.

 

Method: After the 4-year project ended in February 2013, all members of the consortium were asked to anonymously complete a bespoke questionnaire designed by the coordinating team. The purpose of the questionnaire was to capture the views of those who collaborated on the research project in relation to issues of content, context, process and impact of the EquitAble project.

 

Results: Our results indicated some of the successes and challenges encountered by our consortium.

 

Conclusion: We identified contextual and process learning points, factors often not discussed in papers, which typically focus on the reporting of the ‘content’ of results.

National response to disability and HIV in Eastern and Southern Africa

HANASS-HANCOCK, Jill
GRANT, Kitty
February 2010

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Although people with disabilities are often at increased risk of exposure to HIV, this policy brief outlines that less than half of the national strategic plans in Eastern and Southern Africa recognise disability as an issue of concern. Recommendations are provided to governments and civil society on how to address the issue effectively. This policy brief would be useful to people interested in HIV policies in Africa

Disability in national strategic plans on HIV and AIDS : a review on the national response to the interrelations of disability and HIV in eastern and southern Africa|Final report

GRANT, Kitty
STRODE, Ann
HANNASS-HANCOCK, Jill
December 2009

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This report examines national AIDS and HIV strategic plans (NSPs) in eastern and southern Africa and includes findings, discussions and best practice examples on the integration of disability throughout the countries. "Generally, the findings of the report show that less than 50% of the countries in Eastern and Southern Africa recognise disability as an issue of concern, or specifically recognise the vulnerability of people with disabilities to HIV and AIDS within their NSPs. Furthermore, it found that even where countries have recognised disability as an issue, there is limited specific guidance within the NSP on HIV-related service provision to meet the needs of people with disabilities. Only one country, South Africa, showed extensive integration of disability into the various focus areas of its NSP." The report concludes with recommendations and provides detailed appendices of national reports for each country surveyed

HIV/AIDS communication in selected African countries : interventions, reponses and possibilities

PARKER, Warren
RAU, Asta
PEPPA, Penny
2007

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This review looks at communication activities around HIV prevention in 11 countires in South and East Africa operating in 2006 at a national level. It considers the variations in HIV epidemiology between countries, and the heterogeneity within them, and examines the different approaches to communication that are used. The country summaries include a synopsis of the epidemiology, indicators of knowledge, behaviour and service uptake and information about HIV and AIDS prevention communication, activities, approaches and funding

Pain relieving drugs in 12 African PEPFAR countries : mapping current providers, identifying current challenges, and enabling expansion of pain control provision in the management of HIV/AIDS

HARDING, Richard
et al
January 2007

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This study aims to identify current opioid prescribing services and regulatory bodies within 12 African PEPFAR (Presidents Emergency Plan for AIDS Relief ) countries, and to examine the barriers to, and appraise the potential for, expansion in the number of opioid providers, for people with HIV and AIDS according to the World Health Organization pain ladder. It concludes that while there are common issues raised by services and International Narcotics Control Board competent authorities, it is clear that these key stakeholders have concerns regarding the potential roll-out of opioids

Challenges of care : VSO-RAISA regional conference 2007 report back

HAMILTON, Robin
PORTER, Stephen
2007

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"The aim of the conference was to bring together stakeholders from different sectors, in order to create a forum for discussing innovative solutions to emerging issues affecting caregivers in community based organisations. Objectives included focusing on the challenges of care to women and children, identifying good home-based care practices, discussing policy and legal frameworks for home-based care, raising awareness of caregivers’ needs, exploring how to engage men in home-based care, and establishing networks for lobbying and advocacy"

Getting started! : running a junior farmer field and life school|Empowering orphans and vulnerable children living in a world with HIV and AIDS

WIEGERS, Esther
HILL, Catherine
COLBERT, Patricia
2007

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This manual was developed from the experiences of a number of communities and organisations in southern and eastern Africa in creating Junior Farmer Field and Life Schools as a response to the growing number of orphans and vulnerable children. For many reasons these children more likely than other orphans to be at risk from malnutrition, disease, abuse, stigmatisation and sexual exploitation. The risk of sexual exploitation is particularly significant for those left alone to cope with poverty and who are forced to adopt adult roles and ensure food for the rest of the family. As parents and family members become ill, children take on greater domestic, agricultural and income generating responsibilities. HIV and AIDS has a particular impact on girls who are left to care for ailing parents, or who have to become the heads of households upon the death of caregivers. Also, as many parents are dying at a young age orphaned children are growing up without the necessary knowledge and skills for their future livelihood

Using social transfers to improve human development

DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID)
February 2006

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This note provides an introduction to how social transfers - particularly cash transfers and vouchers - can improve human development, particularly for the extreme poor and socially excluded

Addressing violence against women in HIV testing and counselling

WORLD HEALTH ORGANIZATION (WHO)
2006

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This is a summary and recommendations from an international consultation co-convened by the WHO departments of Gender, Women and Health (GWH) and of HIV & AIDS to identify and review promising strategies or good practices to support women who may fear or experience violence as a consequence of HIV testing and/or HIV status disclosure; and develop recommendations to guide programmes and policies related to HIV testing and counselling, in light of current strategies to expand access to these and related services

USAID project profiles : children affected by HIV/AIDS

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
January 2005

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This document presents profiles of 114 projects (90 country-specific, 12 regional, and 12 global) funded by USAID. It includes a section on USAID projects that support access to education in Africa. The project profiles include the names of implementing organisations, funding periods and amounts, objectives, strategies, key accomplishments, priority activities for the year ahead, and materials and tools available to other projects that can help meet the needs of children and youth affected by HIV and AIDS. The diversity of these projects demonstrates the US government's efforts to meet the wide variety of needs of children and youth affected by HIV and AIDS. Approaches vary in both strategy and scale. The vast majority of projects work with communities to identify opportunities that strengthen existing resources without undermining local ownership. In many places, communities are already mobilised and have systems in place to identify, protect, and provide basic necessities to the most vulnerable children. USAID supports the strengthening and monitoring of these existing activities

WHO’s multi-country study on women’s health and domestic violence against women : summary report of initial results on prevalence, health outcomes and women's responses

WORLD HEALTH ORGANIZATION (WHO)
2005

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"Violence against women by an intimate partner is a major contributor to the ill-health of women. This study analyses data from 10 countries and sheds new light on the prevalence of violence against women in countries where few data were previously available. It also uncovers the forms and patterns of this violence across different countries and cultures, documenting the consequences of violence for women’s health. This information has important implications for prevention, care and mitigation... The high rates documented by the Study of sexual abuse experienced by girls and women are of great concern, especially in light of the HIV epidemic. Greater public awareness of this problem is needed and a strong public health response that focuses on preventing such violence from occurring in the first place...This study will help national authorities to design policies and programmes that begin to deal with the problem"

Mapping malaria risk in Africa

MAPPING MALARIA RISK IN AFRICA / ATLAS DU RISKE DE LA MALARIA EN AFRIQUE (MARA/ARMA)
December 2004

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This site presents maps of malaria risk and endemicity (the presence of malaria) in Africa, drawing on published and unpublished data, and through spatial modelling of malaria distribution, seasonality and endemicity. Many factors, especially endemicity, affect the choice of control methods. In the absence of such data it is impossible to rationalize the allocation of limited resources for malaria control. This site presents an opportunity to rethink endemicity and how we may map malaria risk in order to better support planning and programming of malaria control

Processes and issues for improving access to medicines : willingness and ability to utilise TRIPS flexibilities in non-producing countries

BAKER, Brook K.
August 2004

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This paper addresses the varied ways by which a non-medicine producing country may lawfully utilise the agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, primarily by importing. However, it also briefly discusses means for promoting local production through pharmaceutical capacity building and through both compulsory and voluntary licensing. To help decision-makers in understanding and evaluating the opportunities and constraints of each alternative, the paper briefly describes their respective advantages and disadvantages in terms of developing countries’ sustainable access to more affordable medicines, highlighting differing legal interpretations, political realities and pragmatic administrative and economic constraints

Orphans and vulnerable children : taking action, building support. 2004 regional conference report back

VOLUNTARY SERVICE OVERSEAS REGIONAL AIDS INITIATIVE OF SOUTHERN AFRICA (VSO-RAISA)
2004

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This is the report of an annual conference entitled 'Tomorrow’s future, today’s choices. Orphans and Vulnerable Children: Taking action, building support'. The conference included youth delegates from Malawi and Zambia and over three days focused on: care and support; rights, psychosocial support, education and networking; skills building

Guidelines for anti-retroviral therapy

DIRECTORATE OF PRIMARY HEALTH CARE. NATIONAL AIDS COORDINATION PROGRAMME (NACOP)
April 2003

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The HIV/AIDS epidemic affects directly more than 200,000 Namibians. The Ministry of Health and Social Services is mounting an antiretroviral therapy programme to extend access to drug therapy, reduce AIDS mortality rates, improve HIV-positive people's quality of life and produce savings to the health care system. These guidelines aim to assist health practitioners in the implementation of the programme. It identifies standards and best practices for the administration of anti-retroviral drugs to adults, pregnant women and children, and provides essential medical information on ART and treatment options

Tied up in a rope of sand. TFD : cultural action or development utility?

MAVROCORDATOS, Alex
2003

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Discusses the tension and synergy of culture and participatory development through examples of theatre for development experiences in Mali and Namibia. The author describes performances and processes for setting up performance activities in villages, some of which had their own forms of narrative drama, and others which developed these with external support. The article discusses the implications of importing and imposing cultural forms to achieve project goals, and contrasts this with the ethos of theatre for development, which seeks to engage community members in a dialogue with development workers in order to foster participation in and ownership of development activities

Living conditions among people with activity limitations in Namibia : a representative, national survey

EIDE, Arne H
VAN ROOY, Gert
LOEB, Mitch E
2003

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This report presents the findings of a study about the livelihoods of people with disability in Namibia using data from household surveys with and without people with disabilities. The report, one of a series of regional research reports to establish baseline data on living conditions among people in Southern Africa, looks at the fields of health, employment, education, living conditions and services for people with disabilities

Mainstreaming HIV/AIDS : looking beyond awareness

WILKINS, Marissa
VASANI, Dolar
2002

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The social and environmental circumstances that lead vulnerable people to have unprotected sex, exposing them to infections, have to be resolved through addressing the causes of poverty, gender discrimination, and the use of sex as a commodity. This book addresses the impact of HIV without prejudice, by taking a human rights stance. It is useful for trainers, programme planners, policy-makers and CBR programmes

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