Towards an understanding of the political economy of the PPCR

While an analysis of the Pilot Program for Climate Resilience (PPCR) is inseparable from wider discussion on adaptation finance, this article primarily focuses on the drivers and ideologies that shaped the PPCR governance and delivery structures. The core narrative of mainstreaming adaptation into development through a process of government-centred policy reform challenges many principles of the UNFCCC process. Utilising the structures of international financing institutions as implementing agencies, heightens this tension. The central idea of mainstreaming adaptation through climate-proofing existing development initiatives utilises the standard economic growth narrative. This climate ‘add-on’ approach to development allows the World Bank Group and other multilateral development banks (MDBs) to claim a space in managing future climate finance flows. This drive by the Bank plays out in the exclusivity of the design process for the PPCR and through the implementation modalities, which severely curtail opportunities for multi-stakeholder dialogue and thus the potential for development of broad country ownership of programmes

Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda

<p>Abstract</p> <p>Background</p> <p>The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers) and physicians in their decisions as to whether to start therapy.</p> <p>Methods</p> <p>We conducted the study at 12 government antiretroviral therapy sites in three regions of Uganda, all of which had staff trained in delivery of antiretroviral therapy using the WHO Integrated Management of Adult and Adolescent Illness guidelines for chronic HIV care. We collected seven key variables to measure patient assessment and the decision as to whether to start antiretroviral therapy, the primary variable of interest being the Final Antiretroviral Therapy Recommendation. Patients saw either a clinical officer or nurse first, and then were screened identically by a blinded physician during the same clinic visit. We measured inter-rater agreement between the decisions of the non-physician health workers and physicians in the antiretroviral therapy assessment variables using simple and weighted Kappa analysis.</p> <p>Results</p> <p>Two hundred fifty-four patients were seen by a nurse and physician, while 267 were seen by a clinical officer and physician. The majority (> 50%) in each arm of the study were in World Health Organization Clinical Stages I and II and therefore not currently eligible for antiretroviral therapy according to national antiretroviral therapy guidelines. Nurses and clinical officers both showed moderate to almost perfect agreement with physicians in their Final Antiretroviral Therapy Recommendation (unweighted κ = 0.59 and κ = 0.91, respectively). Agreement was also substantial for nurses versus physicians for assigning World Health Organization Clinical Stage (weighted κ = 0.65), but moderate for clinical officers versus physicians (κ = 0.44).</p> <p>Conclusion</p> <p>Both nurses and clinical officers demonstrated strong agreement with physicians in deciding whether to initiate antiretroviral therapy in the HIV patient. This could lead to immediate benefits with respect to antiretroviral therapy scale-up and decentralization to rural areas in Uganda, as non-physician clinicians – particularly clinical officers – demonstrated the capacity to make correct clinical decisions to start antiretroviral therapy. These preliminary data warrant more detailed and multicountry investigation into decision-making of non-physician clinicians in the management of HIV disease with antiretroviral therapy, and should lead policy-makers to more carefully explore task-shifting as a shorter-term response to addressing the human resource crisis in HIV care and treatment.</p

Siyakulwanesive = We are going to fight another tribe

An Umgubo regimental song

The month

Topical song, accompanied by struck metal, regarding a lover who has not come when promised

I have lost my hair-do

Topical song, accompanied by struck metal, referring to how the girls lose the plaited hair that they draw into a wedge or mat on top of their heads

Ndwano siya mani zuminina ngoma ye

Indigenous folk story song with singing, spoken verse and clapping