Introducing a gender-sensitive approach to pre-trial assessment and probation: Evaluation of an innovation in Kenya

This paper evaluates a pioneering project to introduce a gender-sensitive approach to working with women completing probation and community service orders in Kenya. The intervention consisted of context-specific research with women throughout Kenya, leading to adaptations to existing probation tools, followed by pilot implementation of a gender-sensitive approach. The evaluation explores the relevance, effectiveness and sustainability of the intervention and presents opinions of implementing probation officers and sector experts. Findings suggest that the project genuinely broke new ground in terms of research on gender-sensitivity and quality of pre-trial reporting for women. Close adherence to the UN Bangkok Rules means the model and lessons are applicable both domestically and globally

Declining free healthcare and rising treatment costs in India: an analysis of national sample surveys 1986-2004

The article focuses on trends in health-seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three rounds of NSS data on health care use and morbidity pattern during 1986–87, 1995–96 and 2004. With variation across states, treatment-seeking from public providers has declined and preference for private providers has increased over the period. Although overall health-seeking behaviour has improved for both males and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and consider that the illness is not serious enough to require treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between the public and the private has reduced, owing to perhaps increased cost of treatment in public health facilities following the levying of user-fees and curtailing distribution of free medicine. Practically all states reported decline in availability of free both out-patient and in-patient care. The article concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health, particularly in rural and remote areas, and the growing preference of consumers for private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country

Poor People’s Politics in East Timor

YesPoor people attempting to claim a share of resources in post-conflict societies seek allies internationally and nationally in attempts to empower their campaigns. In so doing, they mobilize the languages of liberalism, nationalism and local cultural tradition selectively and opportunistically to both justify stances that transgress the strictures of local culture and to cement alliances with more powerful actors. In the case of poor widows in East Timor, the languages of nationalism, ritual, and justice were intermingled in a campaign aimed at both international actors and the national state in a bid to claim a position of status in the post-conflict order

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

Background: There is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the various dimensions of UHC emerging from these interpretations and argues for the need to pay attention to the complex interactions across the various components of a health system in the pursuit of UHC as a legal human rights issue. Discussion: The literature presents UHC as a multi-dimensional concept, operationalized in terms of universal population coverage, universal financial protection, and universal access to quality health care, anchored on the basis of health care as an international legal obligation grounded in international human rights laws. As a legal concept, UHC implies the existence of a legal framework that mandates national governments to provide health care to all residents while compelling the international community to support poor nations in implementing this right. As a humanitarian social concept, UHC aims at achieving universal population coverage by enrolling all residents into health-related social security systems and securing equitable entitlements to the benefits from the health system for all. As a health economics concept, UHC guarantees financial protection by providing a shield against the catastrophic and impoverishing consequences of out-of-pocket expenditure, through the implementation of pooled prepaid financing systems. As a public health concept, UHC has attracted several controversies regarding which services should be covered: comprehensive services vs. minimum basic package, and priority disease-specific interventions vs. primary health care. Summary: As a multi-dimensional concept, grounded in international human rights laws, the move towards UHC in LMICs requires all states to effectively recognize the right to health in their national constitutions. It also requires a human rights-focused integrated approach to health service delivery that recognizes the health system as a complex phenomenon with interlinked functional units whose effective interaction are essential to reach the equilibrium called UHC

Using smart pumps to help deliver universal access to safe and affordable drinking water

It is estimated that broken water pumps impact 62 million people in sub-Saharan Africa. Over the last 20 years, broken handpumps have represented US$1·2–1·5 billion of lost investment in this region, with 30–40% of rural water systems failing prematurely. While the contributory factors are complex and multi-faceted, the authors consider that improved post-construction monitoring strategies for remote water projects, which rely on smart pumps to monitor operational performance in place of physical site visits, may address some of these problems and help reduce the heavy time and resource demands on stakeholders associated with traditional monitoring strategies. As such, smart pumps could play a significant role in improving project monitoring and might subsequently help deliver universal access to safe and affordable drinking water by 2030, which constitutes one of the key targets of United Nations sustainable development goal 6 and is embedded in some national constitutions

Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa

There are three dominant globalization pathways affecting noncommunicable diseases in Sub-Saharan Africa (SSA): urbanization, trade liberalization, and investment liberalization. Urbanization carries potential health benefits due to improved access to an increased variety of food imports, although for the growing number of urban poor, this has often meant increased reliance on cheap, highly processed food commodities. Reduced barriers to trade have eased the importation of such commodities, while investment liberalization has increased corporate consolidation over global and domestic food chains. Higher profit margins on processed foods have promoted the creation of ‘obesogenic’ environments, which through progressively integrated global food systems have been increasingly ‘exported’ to developing nations. This article explores globalization processes, the food environment, and dietary health outcomes in SSA through the use of trend analyses and structural equation modelling. The findings are considered in the context of global barriers and facilitators for healthy public policy.Department of HE and Training approved lis

Gender, risk and the Wall Street alpha male

From the outset, analyses of the 2008 financial crisis, in mainstream as well as feminist discussions, have been gendered. In particular, rampant risk taking in an unregulated environment, widely deemed to be a principle cause of the crash, has been associated with masculine characteristics. In this article I explore how the concepts of gender and risk entwine in two films on the financial crisis – The Other Guys and Margin Call. By looking at how gender is used to dramatise financial risk, I explore how understandings of high risk behaviour are gendered, and the implications this has in the context of finance. Fictional representations mediate public understanding of this notoriously complex field, as the number of films and documentaries on the crisis demonstrates. Exploring how gender is used to communicate risk reminds us that risk taking is part of a performance of masculinity that needs to be established by constructing a feminine, risk-averse other. The contention of this paper is that to address gender bias in finance and the economy, gendered meanings of risk need to be openly challenged, and cultural and material analyses of gendered inequality brought into dialogue

Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya’s devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans

Appraisal of second integrated dairy development project

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State incapacity by design : understanding the Bihar story

governed particularly badly between 1990 and 2005, and has since experienced something of a ‘governance miracle’. How can we account for the 1990–2005 deterioration? The answer lies in the interaction of three factors. The first was the type of leadership exercised by Lalu Prasad Yadav, who was Chief Minister throughout most of this period – even when his wife formally occupied the post. The second lies in electoral politics: the need to maintain the enthusiasm and morale of an electoral coalition that Yadav had constructed from a number of poorer and historically oppressed groups. Such was the scale of poverty among this core electoral coalition that Yadav had limited prospects of maintaining its cohesion and allegiance through the normal processes of promising ‘development’ and using networks of political patronage to distribute material resources to supporters. More important, that strategy would have involved a high level of dependence on the government apparatus, that was dominated by people from a number of historically-dominant upper castes. That is our third factor. Yadav preferred to mobilise his supporters on the basis of continual confrontation with this historically oppressive elite. He kept public sector jobs vacant rather than appoint qualified people – who were mainly from the upper cases. He tried to micro-manage the state apparatus from the Chief Minister’s office. He denuded the public service of staff. He was then unable to use it to deliver ‘development’. We show that, among other things, the Bihar state government sacrificed large potential fiscal transfers from the Government of India designed for anti-poverty programmes because it was unable to complete the relevant bureaucratic procedures. Yadav knowingly undermined the capacity of the state apparatus. There are parallels in many other parts of the world. Low state capacity is often a political choice. Keywords: India; Bihar; politics; capacity building; state capacity; governance