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Journal articles on the topic 'Health services – Lesotho – Roma'
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Mugomeri, Eltony, Dedré Olivier, and Elmien van den Heever-Kriek. "The effect of tenofovir in renal function in HIV-positive adult patients in the Roma health service area, Lesotho, southern Africa." Journal of the International AIDS Society 17 (November 2014): 19681. http://dx.doi.org/10.7448/ias.17.4.19681.
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Obioha, Emeka E., and Masemote G. Molale. "Functioning and Challenges of Primary Health Care (PHC) Program in Roma Valley, Lesotho." Studies on Ethno-Medicine 5, no. 2 (August 2011): 73–88. http://dx.doi.org/10.1080/09735070.2011.11886393.
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Rusi, Nadia. "Discrimination of Roma Women Regarding Their Access to Reproductive Health Services in Albania." European Journal of Multidisciplinary Studies 4, no. 1 (January 21, 2017): 41. http://dx.doi.org/10.26417/ejms.v4i1.p41-50.
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The situation of Roma women regarding the provision of the reproductive health services is a sensitive issue in the Albanian reality, in the framework of the implementation of the fundamental rights and in the framework of achieving social justice. Previous reports with their focus on “Roma population” have brought surveys related to different fields, including employment, education and estimation of the general situation of Roma community in such fields. From this point of view it is estimated that there is a lack of special reports treating only the situation of Roma women, in different aspects of their economic, social, cultural life and their health as well. Furthermore, a review of the previous literature in such a field shows a lack of study regarding the situation of Roma women in their access to reproductive health services. Taking into consideration the reasons mentioned above, this paper aims to serve as an orientation for the course of the State - Community Policies in such a field. The paper is focused in three main aspects: analysis of the Albanian normative framework in regard to reproductive health, situation of Roma women regarding their access in reproductive health services and drawing conclusions regarding the equal treatment of Roma women in the field of reproductive health.
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Kozubik, Michal, Jitse P. van Dijk, and Ivan Rac. "Health Risks Related to Domestic Violence against Roma Women." International Journal of Environmental Research and Public Health 17, no. 19 (September 24, 2020): 6992. http://dx.doi.org/10.3390/ijerph17196992.
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Background: Data on Roma women’s experience of violence from their male partners are very scarce. We explored the process of actual domestic violence against Roma women, the threat of violence and its health consequences. We further focused on barriers in the availability of specialized support services aimed at eliminating domestic violence. Methods: The sample included 20 Roma women living throughout Slovakia: scattered among the majority (45.0%), in crisis centers and sheltered houses (40.0%), and in segregated Roma settlements (15.0%). Data were obtained through qualitative research by means of semi-structured interviews in 20 individual case studies. All 20 women had experienced a combination of violence: physical, psychological and economic, all of them connected with social isolation. Results: Prevailing gender stereotypes are a precondition of domestic violence against women, regardless of their status. Violence against Roma women resulted in several health consequences, and all of the 20 women suffered from these. Most of them reported general psychological problems (75%), among which anxiety and depression (25%), headache (25%), weight loss (10%) and health problems connected with motor activity (5%). The barriers include lack of awareness among Roma women of any specialised support services and the absence of such services for abused women in the region. Conclusions: Domestic violence results in serious psychological and physical health consequences. Violence elimination is generally set up without a specific ethnic or gender approach. Disregard of these specifics can lead to deepening of the uneven position of Roma women within the family, community and society, and the acceptance of violence against Roma women.
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Garcia-Espinel, Tania, Laura Aso, Gisela Redondo-Sama, and Ainhoa Flecha. "Roma Never Die Alone." Qualitative Health Research 27, no. 14 (September 14, 2017): 2189–200. http://dx.doi.org/10.1177/1049732317729138.
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A common characteristic of Roma as a cultural group is that they do not allow their elderly to die alone. Nevertheless, rooted in a mainstream cultural perspective of health provision services, public institutions usually do not allow Roma people to be with their loved ones in their last moments. Following the communicative methodology, we conducted a communicative case study on the death of the most relevant female Roma leader in Catalonia. She was accompanied by more than two hundred family members and friends in her room and corridor at an important hospital in Barcelona. We performed our research in the 2 years following her death to obtain the reflections of the Roma members involved. These reflections revealed the egalitarian dialogue forged between these Roma members and the hospital personnel, which enabled the former to embrace their culture and support their loved ones before death. Because this dialogue was possible and fruitful, the acknowledgment of cultural diversity and the improvement of the quality of services offered to Roma might also be possible in other health institutions.
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Lucheş, Daniel, Despina Vasilcu, and Ionela Gălbău. "Health and Education in Roma Families. Comparative Study, Romanian Roma Families from Rennes, France vs. Roma from Mironu, Suceava, Romania." European Review Of Applied Sociology 9, no. 12 (June 1, 2016): 48–54. http://dx.doi.org/10.1515/eras-2016-0005.
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AbstractThe lower level of education for health and school education among vulnerable groups from Romania is an important part of the vicious circle of poverty and social removal, in particular for Roma minority. The quality of education and health related to this minority group is correlated with cultural aspects and the Roma attitude toward those determinants factors.The study relies on data obtained after questioning a number of 50 people, Roma that immigrated in Rennes, France and 50 Roma from Mironu, Valea Moldovei County, Suceava city. The results of the research show a considerable difference between the attitude of the Roma people from France compared with the attitude of the Romas from Romania regarding the health services and the education that they benefit. The immigrants have a positive attitude regarding the school and the medical services, after applying the quiz it can be said that they are pretty unpleased of the Romanian services than the foreign ones.Although, the Roma minority has the support of the authorities in Rennes and also in Mironu, support for social inclusion and adaptation in a local community, but they are reluctant in accepting these benefits. The programs developed for helping them hadn’t had the expected results, though.Health and education have a specific purpose in developing the society in general. Now we can say that solving the problem with the access to education and health for Roma minority represents the key of their social and economic integration.
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Jarcuska, Pavol, Daniela Bobakova, Jan Uhrin, Ladislav Bobak, Ingrid Babinska, Peter Kolarcik, Zuzana Veselska, and Andrea Madarasova Geckova. "Are barriers in accessing health services in the Roma population associated with worse health status among Roma?" International Journal of Public Health 58, no. 3 (April 2, 2013): 427–34. http://dx.doi.org/10.1007/s00038-013-0451-8.
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Ezer, Tamar, Alphia Abdikeeva, and Martin McKee. "Legal advocacy as a tool to advance Roma Health." Health Economics, Policy and Law 13, no. 1 (September 7, 2017): 92–105. http://dx.doi.org/10.1017/s1744133117000238.
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AbstractRoma in central Europe face many violations of their rights, including those that impede their access to high-quality health care. Legal frameworks have the potential to address these violations, whereas legal advocacy services offer a means for enforcement of rights. We undertook key informant interviews with Roma civil society organisations and selected knowledgeable individuals in Macedonia, Romania and Serbia to identify lessons from the development of these services. Achievements were reported in four areas. Legal empowerment, with employment of Roma paralegals was especially effective, increasing awareness of the ability to challenge violations. Documentation of human rights violations is an important basis for advocacy, but does not guarantee redress, and may work best in combination with legal empowerment or international pressure. Strategic litigation can play a key role in removing bureaucratic obstacles that prevent Roma from exercising their right to access to health care. Progress in changing the narrative on Roma in the mainstream media has been limited but examples of good practice exist. Although much remains to be done, Roma groups report that legal advocacy has strengthened their ability to challenge rights violations, thereby enhancing their ability to access effective and responsive care.
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Obioha, Emeka E., and Mots’elisi Matsela. "Social Costs and Benefits of Community Home Based Health Care (CHBHC) Delivery System in Roma Valley, Lesotho." Studies on Ethno-Medicine 7, no. 2 (August 2013): 115–26. http://dx.doi.org/10.1080/09735070.2013.11886452.
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ADAIR, TIMOTHY. "UNMET NEED FOR CONTRACEPTION AMONG HIV-POSITIVE WOMEN IN LESOTHO AND IMPLICATIONS FOR MOTHER-TO-CHILD TRANSMISSION." Journal of Biosocial Science 41, no. 2 (March 2009): 269–78. http://dx.doi.org/10.1017/s0021932008003076.
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SummaryIn Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26·4%), low knowledge of HIV status and a total fertility rate of 3·5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15–49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.
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Lämsä, Riikka, Anu E. Castaneda, Anneli Weiste, Marianne Laalo, Päivikki Koponen, and Hannamaria Kuusio. "The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults." International Journal of Environmental Research and Public Health 17, no. 16 (August 12, 2020): 5825. http://dx.doi.org/10.3390/ijerph17165825.
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The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods.
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de Graaf, Pim, Danica Rotar Pavlič, Erika Zelko, Marga Vintges, Sara Willems, and Lise Hanssens. "Primary care for the Roma in Europe: Position paper of the European forum for primary care." Slovenian Journal of Public Health 55, no. 3 (September 1, 2016): 218–24. http://dx.doi.org/10.1515/sjph-2016-0030.
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Abstract Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people.
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Filčák, Richard, and Daniel Škobla. "Sanitation Infrastructure at the Systemic Edge: Segregated Roma Settlements and Multiple Health Risks in Slovakia." International Journal of Environmental Research and Public Health 18, no. 11 (June 4, 2021): 6079. http://dx.doi.org/10.3390/ijerph18116079.
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This article explores how multiple health risks in municipalities with Roma settlements in Slovakia are related to the varieties of local governance and the authorities’ conduct towards the local Roma population. The first part of the paper describes the situation in Roma settlements from the perspective of unequal access to sewerage and water pipelines. Introduced here are data on identified contagious diseases that correlated multiple health risks with the lack of sanitation and/or water infrastructure. The second section of the paper put forth typologies of government approaches towards the Roma, which based on ethnographic fieldwork, allows us to identify factors of attitudinal, structural and policy-oriented nature. Research results point to a “triad” of key circumstances: these are the structural conditions in municipalities and the history of local inter-ethnic relations and attitude of authorities towards Roma. Finally, possible solutions and approaches regarding how to mitigate the multiple health risks are discussed. It is suggested that on the one hand, in many villages there is a profound institutional discrimination of Roma with respect to water and sanitation infrastructure; on the other hand, water services are increasingly becoming an expensive commodity that not everyone can afford. The article concludes with discussion on enabling conditions and ways to ensure access to basic infrastructure in rural Roma communities. The solution is not only a compliance with principles of non-discrimination and existing technical norms and standards but also in securing the accessible funding for construction of the sanitation infrastructure in a smart way, including innovations and operation of cheaper and environmentally responsible sanitation technologies.
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McFadden, Alison, Lindsay Siebelt, Anna Gavine, Karl Atkin, Kerry Bell, Nicola Innes, Helen Jones, Cath Jackson, Haggi Haggi, and Steve MacGillivray. "Gypsy, Roma and Traveller access to and engagement with health services: a systematic review." European Journal of Public Health 28, no. 1 (January 16, 2018): 74–81. http://dx.doi.org/10.1093/eurpub/ckx226.
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Varga, Bernadett Mária. "Access to healthcare services for the Roma and undocumented migrants in the EU in light of the Covid-19 pandemic." International Journal of Roma Studies 2, no. 2 (September 15, 2020): 4. http://dx.doi.org/10.17583/ijrs.2020.5952.
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Background. The rising number of the EU Roma citizens from the CEE countries, non-EU Roma citizens from the Western-Balkans, and of undocumented migrants in the European Union makes it interesting to see that most of them face barriers when accessing health services [with a European Health Insurance Card (EHIC)] or have no health coverage at all [no legal entitlement]. European migrant health policies are seemingly well structured and responsive to the needs of migrants, however, results of recent studies raise the question whether the legislations are responsive enough to the needs of the Roma and undocumented migrants when accessing health services. Given the circumstances of the Covid-19 pandemic these groups are now at an increased risk and they might not be able to understand how the virus transmits and how they can protect themselves from it. Methods. Literature review focusing on the access to health services and migrant health policies in the EU and the UK was carried out. The target groups of this research were Roma citizens and third-country national undocumented migrants residing in the European Union. Results. In theory the legal entitlement for accessing healthcare for migrants in general is satisfactory, while in practice these groups face difficulties, such as prejudice, discrimination and other barriers (language, logistical) when approaching health services. Migrants lack trust in the health system and the healthcare professionals, and are not aware of their fundamental rights to healthcare either. Conclusions. Legal entitlements for EU migrant citizens do not differ within EU countries but they significantly vary for undocumented migrants Europe-wide and there seems to be a mismatch between the legal entitlements for undocumented migrants in theory and their implementation in practice. Given the circumstances of the pandemic these groups are at an increased risk and therefore their health inclusion through health literacy programs should take place, as well as health workers should be trained on diversity in order to establish diversity adapted EU health systems. Seeking adaptive practices to establish cultural diversity within the healthcare settings, and introducing the universal health coverage scheme Europe-wide in order for undocumented migrants and EU citizens without employment to benefit from proper healthcare services is encouraged and necessary.
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Thabane, Motlatsi. "Public mental health care in colonial Lesotho: themes emerging from archival material, 1918–35." History of Psychiatry 32, no. 2 (February 18, 2021): 146–61. http://dx.doi.org/10.1177/0957154x21989176.
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This paper identifies some of the themes that emerge from a study of official archival records from 1918 to 1934 on the subject of mental health in colonial Lesotho. They include: difficulties experienced by colonial medical doctors in diagnosing and treating mental illnesses, given the state of medical knowledge in the nineteenth and early twentieth centuries; impact of shortage of financial and other resources on the establishment and operation of medical services, especially mental health care; convergence of social order, financial and medical concerns as influences on colonial approaches to mental health care; and the question of whether Basotho colonial society saw institutionalization of their relatives as ‘hospitalization’ or ‘imprisonment’. Two case studies are presented as preliminary explorations of some of the themes.
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D'arcy, Michelle. "Non-state actors and universal services in Tanzania and Lesotho: state-building by Alliance." Journal of Modern African Studies 51, no. 2 (May 17, 2013): 219–47. http://dx.doi.org/10.1017/s0022278x13000190.
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ABSTRACTIn recent years over half of all African states have re-introduced some form of universal basic service provision, though many more have done so in education when compared with health. Most existing explanations of these developments have emphasised the importance of demand side factors associated with democratisation. This paper argues that while democratisation has been important in generating pressure for reform, alliances with actors outside the state – such as donors and non-state service providers – have been the critical enabling factor allowing weak states to overcome their capacity constraints and respond. Two illustrative case studies are used to show how variation in alliance opportunities has led to differences in outcomes both between social sectors and across countries. An inter-sector comparison of health and education policy in Tanzania shows how a difference in donor policy preferences between sectors – donors having converged behind the principle of universal primary education but not universal healthcare – has led to variation in alliance opportunities and hence policy outcomes. A ‘least likely’ case of healthcare reform in Lesotho shows how an alliance with a non-state provider has made difficult reforms possible.
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Pepperall, J., P. Garner, J. Fox-Rushby, N. Moji, and T. Harpham. "Hospital or health centre? a comparison of the costs and quality of urban outpatient services in Maseru, Lesotho." International Journal of Health Planning and Management 10, no. 1 (January 1995): 59–71. http://dx.doi.org/10.1002/hpm.4740100106.
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Sándor, János, Zsigmond Kósa, Klára Boruzs, Julianna Boros, Ildikó Tokaji, Martin McKee, and Róza Ádány. "The decade of Roma Inclusion: did it make a difference to health and use of health care services?" International Journal of Public Health 62, no. 7 (March 29, 2017): 803–15. http://dx.doi.org/10.1007/s00038-017-0954-9.
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Anghel, Ionuţ Marian. "New Forms of Government and the Europenisation of Minority Representation: the Case of European Roma." European Journal of Social Sciences Education and Research 1, no. 1 (May 1, 2014): 48. http://dx.doi.org/10.26417/ejser.v1i1.p48-55.
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The situation of roma since the fall of socialism is a paradox. On the one hand, many organizations, international governing organizations (IGOs), such as the European Union (Council of Europe, European Commission, European Parliament), the Organization for Security and Cooperation in Europe, the World Bank and the United Nations (UNDP, UNICEF, ILO), local and international/transnational NGOs, government agencies are involved in projects for Roma to improve their situation in Europe. Roma have become the target of social inclusion programs of the European Union (EU), the Decade of Roma Inclusion - a project of the Open Society Foundation and the World Bank -, Strategies for improving the situation of Roma developed by governments in Southeastern Europe. On the other hand, Roma continue to be marginalized, discriminated against, politically underrepresented, with a higher probability of being unemployed, not having access to public services - education, health , housing - compared with the majority population. This paper seeks to understand how was it possible to understand the recent shift from the representation of the Roma as a non-European minority, which lasted since their arrival in Europe until the fall of socialist regimes, to their representation as an European minority as it is shown in documents of the European institutions and the World Bank? How did Roma appear on the EU social inclusion agenda, the Human Development agenda of UNDP or the minority rights agenda of OSCE?
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Letsie, Thandiwe Marethabile, and Mafusi Jemina Mokone. "Hindering Factors towards Male Participation in the PMCTCT HIV/AIDS Prevention Program: A Case of Lesotho." Global Journal of Health Science 13, no. 3 (February 10, 2021): 101. http://dx.doi.org/10.5539/gjhs.v13n3p101.
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HIV/AIDS remains a concern in many countries globally. Different governments have put in place preventative measures aimed at ensuring healthy nations. PMCTC HIV/AIDS as one antenatal preventive program, is a safe motherhood initiative offering comprehensive reproductive services that are more inclusive. A qualitative descriptive and explorative achieved through in-depth one-to-one interviews done established factors hindering the males in Lesotho from participating in the prevention of mother to child human immunodeficiency virus transmission (PMTCT). Tesch approach was used to analyse qualitative data and the following four themes emerged; Socio-cultural practices, lack of time by most men who are working, inadequate information to the male partners regarding reproductive related issues and educative strategies. The concerns raised by Basotho men are enlightening and call for management of health care services to align research with transformative legislation influencing reproductive health care policy. Measures aimed at improving internal processes within PMCTC umbrella address administrative issues compromising care. Therefore, constant capacity development on nursing teams to buy-into offering inclusive client centred PMCTC services is a sensible approach.
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Lepheana, Relebohile Juliet, James Wabwire Oguttu, and Daniel Nenene Qekwana. "Spatial Patterns of Anthrax Outbreaks and Cases among Livestock in Lesotho, 2005–2016." International Journal of Environmental Research and Public Health 17, no. 20 (October 19, 2020): 7584. http://dx.doi.org/10.3390/ijerph17207584.
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Background: Although anthrax occurs globally, the burden of the disease remains particularly high in Africa. Furthermore, the disease anthrax has significant public health and economic implications. However, sufficient attention has not been given to the geographic distribution of anthrax outbreaks and cases in Lesotho. Therefore, this study investigates the spatial patterns of anthrax outbreaks and cases among livestock in Lesotho from 2005 to 2016. Methods: A cross-sectional study design was adopted to realise the objectives of this study using retrospective data of anthrax outbreaks and cases recorded by the Department of Livestock Services (DLS) between 2005 and 2016. Anthrax outbreaks were geo-coded at village level and aggregated at district level. Proportions and 95% CI of anthrax outbreaks and cases by village and district were calculated. Cartographic maps displaying the distribution of anthrax outbreaks and cases at village and district level were constructed. Results: A total of 38 outbreaks were reported over the study period, and they were clustered in the Lowlands districts of Lesotho. Most outbreaks (52.6%, 20/38) in livestock were reported in the Maseru district. The Leribe district reported the lowest proportions of outbreaks (5.3%, 2/38) and cases (0.6%, 3/526). At the village level, 18% (7/38) of outbreaks were in Maseru Urban, followed by Ratau (16%, 6/38) and Mofoka (13%, 5/38). The Maseru district reported the highest (1.3%, 369/29,070) proportion of cases followed by Mafeteng (0.9%, 73/8530). The village with the most cases was Kolo (10.5%, 21/200), followed by Thaba-Chitja (7.7%, 33/430). Conclusion: Anthrax outbreaks and cases exclusively occur in the Lowlands districts of Lesotho, with villages such as Mahobong, Pitseng, Kolo, and Thaba-Chitja having a higher risk of anthrax disease. Findings of the present study have serious public health implications in light of the fact that between 2003 and 2008 Lesotho’s main abattoir was closed; hence, most of the meat in Lesotho was imported and/or sourced from the informal slaughter facilities. Much larger studies are needed to further investigate factors contributing to spatial disparities in anthrax outbreaks and cases observed in this study. Findings of the present study can be used to guide the formulation of a policy on prevention and control of anthrax in Lesotho.
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Siebelt, Lindsay, Cath Jackson, Alison McFadden, Lisa Dyson, and Karl Atkin. "Use of UK health services by Gypsies, Roma, and Travellers: triangulation of two mixed methods studies." Lancet 390 (November 2017): S81. http://dx.doi.org/10.1016/s0140-6736(17)33016-7.
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Colombini, Manuela, Bernd Rechel, and Susannah H. Mayhew. "Access of Roma to sexual and reproductive health services: Qualitative findings from Albania, Bulgaria and Macedonia." Global Public Health 7, no. 5 (May 2012): 522–34. http://dx.doi.org/10.1080/17441692.2011.641990.
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Senekane, Mpinane Flory, Agnes Makhene, and Suzan Oelofse. "Methodology to Investigate Indigenous Solid Waste Systems and Practices in the Rural Areas Surrounding Maseru (Kingdom of Lesotho)." International Journal of Environmental Research and Public Health 18, no. 10 (May 18, 2021): 5355. http://dx.doi.org/10.3390/ijerph18105355.
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Solid waste management (SWM) is the greatest challenge facing environmental protection and human wellbeing in the rural communities of Maseru (Kingsom of Lesotho). A lack of formal waste management (WM) systems in rural areas of Maseru have resulted in different indigenous systems and practices of SWM. Direct observation and descriptive designs will be employed. This is a mixed methods study of qualitative, quantitative and, non-experimental. We obtained data sets from existing official census and statistics of Maseru. We sampled 693 participants from total population of 6917. We received ethical clearance from Research Ethics committee of Health Sciences at the University of Johannesburg, we recruited six field workers. We have preventive equipment (sanitizers, masks, and sterile latex gloves) for COVID-19 infections in place; we have specific design on caps, masks and bags that will identify field workers as they collect data. We will train field workers, administer questionnaires, interview, and observe participants. STATKON will analyse data. The research will share the results with the Ministry of Environment and the community in Lesotho. The results will also be used to educate the rural communities on improved WM. Where weaknesses are identified, mitigation measures can be evaluated and implemented to rectify the negative aspects and improve the systems and practices. The rural communities face challenges such as waste collection services and sanitation facilities and this fact points out that there is a gap in SWM, which favours the existence of indigenous systems and practice of SWM.
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Letsie, Thandiwe Marethabile, and Matjeko Lenka. "Factors Contributing to the Late Commencement of Antenatal Care at a Rural District Hospital in Lesotho." Global Journal of Health Science 13, no. 5 (March 30, 2021): 32. http://dx.doi.org/10.5539/gjhs.v13n5p32.
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Antenatal care (ANC) is a key approach aimed at improving maternal and infant health. Numerous factors are associated with late commencement of antenatal care. Sub-Saharan Africa countries are exception to the problem of late commencement of antenatal care. The qualitative, explorative, descriptive and contextual approach was followed. The pregnant women meeting the inclusion criteria, were above 16 weeks and attended antenatal care at the time of the study. Different authorities granted permission to conduct face-to-face, unstructured in-depth interviews. Tesch approach enabled the qualitative researchers to immerse themselves through systematic organization and synthesis of data to create manageable units. an independent co-coder also analyzed data independently. Afterwards, they met and agreed on specific themes and sub-categories. The following five themes emerged; personal and family factors, cultural beliefs and practices, health systems and poor infrastructure. Measures aimed at improving accessibility to the health centers include; road infrastructure, telecommunication and more client centered services. Improvement of early commencement of antenatal services becomes an ideal approach influencing excellent maternal and neonatal outcomes. Therefore, government initiatives aimed at empowering communities on the benefits of commencing antenatal care on time is necessary.
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Sándor, János, Zsigmond Kósa, Klára Boruzs, Julianna Boros, Ildikó Tokaji, Martin McKee, and Róza Ádány. "Erratum to: The decade of Roma Inclusion: did it make a difference to health and use of health care services?" International Journal of Public Health 62, no. 7 (May 8, 2017): 817. http://dx.doi.org/10.1007/s00038-017-0973-6.
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Ádány, Róza, Péter Pikó, Szilvia Fiatal, Zsigmond Kósa, János Sándor, Éva Bíró, Karolina Kósa, et al. "Prevalence of Insulin Resistance in the Hungarian General and Roma Populations as Defined by Using Data Generated in a Complex Health (Interview and Examination) Survey." International Journal of Environmental Research and Public Health 17, no. 13 (July 4, 2020): 4833. http://dx.doi.org/10.3390/ijerph17134833.
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Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden’s method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35–49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services.
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Kaluski, Dorit Nitzan, Kristefer Stojanovski, Gerry McWeeney, Elizabet Paunovic, Piroska Ostlin, Lucianne Licari, and Zsuzsanna Jakab. "Health insurance and accessibility to health services among Roma in settlements in Belgrade, Serbia—the journey from data to policy making." Health Policy and Planning 30, no. 8 (September 17, 2014): 976–84. http://dx.doi.org/10.1093/heapol/czu101.
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Hellowell, Mark. "Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho." BMJ Global Health 4, no. 2 (April 2019): e001217. http://dx.doi.org/10.1136/bmjgh-2018-001217.
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Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs—even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.
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Madiba, Sphiwe, and Mamorapeli Putsoane. "Testing Positive and Disclosing in Pregnancy: A Phenomenological Study of the Experiences of Adolescents and Young Women in Maseru, Lesotho." AIDS Research and Treatment 2020 (February 12, 2020): 1–8. http://dx.doi.org/10.1155/2020/6126210.
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The routine antenatal screening through the prevention of mother to child transmission of HIV (PMTCT) services results in pregnancy being often the point at which an HIV diagnosis is made. Disclosure to partners presents particular complexities during pregnancy. However, research on the pattern and experiences of disclosure in pregnancy is limited in Lesotho, despite the high prevalence of HIV among pregnant women. The aim of this study was to explore and describe the disclosure experiences of adolescent girls and young women (AGYW) after receiving a positive HIV test result during pregnancy. Methods. Descriptive phenomenology using semistructured in-depth interview was used to collect data from AGYM sampled purposively from PMTCT sites located in urban areas of Maseru, Lesotho. Data analysis was inductive and followed the thematic approach. Findings. There were 15 AGYW involved in this study with the mean age of 20 years. Fourteen reported being pregnant with their first child and perceived HIV testing in antenatal care as compulsory. Ten AGYM disclosed their HIV status in the immediate posttesting period to protect their partners from HIV infection. The narratives revealed that the AGYM hoped that after disclosing, the partner would be tested for HIV. Furthermore, the AGYM disclosed because they wanted freedom to take their medication. Their experience of disclosure was relief, as they did not have to hide their HIV status. The AGYM reported being supported to adhere to medication and clinic attendance by their partners who also provided emotional support to them to deal with being HIV positive and pregnant. Conclusion. The AGYM recounted an overall positive experience of disclosure to their partners who agreed to test for HIV and adopted safe sex practices. This has positive implications for the PMTCT programme and the involvement of men in reproductive health. Therefore, there is need to integrate disclosure and partner testing interventions in the cascade of services in PMTCT programmes.
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A. Ranotsi and S. Aiyuk. "Impact of the Pension on Access to Health and Selected Food Stuffs for Pensioners of the Manonyane Community in Roma, Lesotho as Measured between 2004 and 2006." Healthy Aging & Clinical Care in the Elderly 4 (2012): 27–31. http://dx.doi.org/10.4137/hacce.s8565.
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Usera-Clavero, Marisa, Diana Gil-González, Daniel La Parra-Casado, Carmen Vives-Cases, Pilar Carrasco-Garrido, and Pablo Caballero. "Inequalities in the use of gynecological visits and preventive services for breast and cervical cancer in Roma women in Spain." International Journal of Public Health 65, no. 3 (January 14, 2020): 273–80. http://dx.doi.org/10.1007/s00038-019-01326-w.
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Hognogi, Gheorghe-Gavrilă, Ana-Maria Pop, and Alexandra-Camelia Marian-Potra. "Faces of Marginal Housing in Romania." Sustainability 13, no. 7 (April 2, 2021): 3983. http://dx.doi.org/10.3390/su13073983.
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Marginal settlements may be defined as inhabited areas characterized by a series of negative features, typicallyethnic segregation, social discrimination, poor living conditions and conflicts, with impact on their dwellers and neighboring communities. In Romania, informal settlements were legislated in 2019; it subsequently became mandatory for the local authorities to spatially delimit them and formulate measures to improve living conditions. However, there are still numerous issues to be solved, from the lack of basic services (health, education) to the persistent poor living conditions or serious environmental problems. The Roma communities selected for our study are no exception. They are located on the outskirts of some cities or in their historical centers (Cluj-Napoca, Sibiu, Timișoara, Baia Mare). Through content analysis, based on print and electronic media from the last 10 years (n = 150 news items), different aspects of marginal housing were illustrated. The results of the study revealed some particular aspects, namely: some of the Roma communities are relocated whilst some others are subject to environmental conflicts; funding addressing the quality of life of Roma ethnics seems to deepen the phenomenon of segregation among communities, most of the measures being limited to the creation of housing facilities.
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Leclerc, P. M., and M. Garenne. "Commercial sex and HIV transmission in mature epidemics: a study of five African countries." International Journal of STD & AIDS 19, no. 10 (October 2008): 660–64. http://dx.doi.org/10.1258/ijsa.2008.008099.
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The study compares the association between using the services of commercial sex workers and male HIV seroprevalence in five African countries: Ghana, Kenya, Lesotho, Malawi and Rwanda. The HIV seroprevalence among men who ‘ever paid for sex’ was compared with controls who ‘never paid for sex’. Results were based on 12,929 eligible men, aged 15–59 years, interviewed in Demographic and Health Surveys. The odds ratio of HIV seroprevalence associated with ever paying for sex was 1.89 (95% confidence interval = 1.57–2.28), with only minor differences by country. The results were stable in multivariate analysis after controlling for available potential cofactors (data on non-sexual routes of transmission were not available). Given the relatively small proportion of men involved, the risk attributable to ‘ever paying for sex’ remained low: 7.1% in univariate analysis and 4.4% after adjustment, and it varied among countries (range 1.3–9.4%). These results match previous observations that commercial sex seems to play a minor role in the spread of HIV in mature epidemics.
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Jackson, Cath, Lisa Dyson, Helen Bedford, Francine M. Cheater, Louise Condon, Annie Crocker, Carol Emslie, et al. "UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study." Health Technology Assessment 20, no. 72 (September 2016): 1–176. http://dx.doi.org/10.3310/hta20720.
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BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations.Aims(1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study.MethodsThree-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions.ResultsThere were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five ‘top-priority’ interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation.LimitationsNo Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups.Future workTo include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities.Study registrationCurrent Controlled Trials ISRCTN20019630 and UK Clinical Research Network Portfolio number 15182.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 72. See the NIHR Journals Library website for further project information.
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Rajan, Selina, Walter Ricciardi, and Martin McKee. "The SDGs and health systems: the last step on the long and unfinished journey to universal health care?" European Journal of Public Health 30, Supplement_1 (March 1, 2020): i28—i31. http://dx.doi.org/10.1093/eurpub/ckaa035.
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Abstract In 2015, the world’s governments committed, in the Sustainable Development Goals (SDGs), to achieve universal health coverage by 2030, something they will be held accountable for. We examine progress in the WHO European Region using data from several sources. We assess effective coverage using data from the Global Burden of Disease Programme, including access to 9 key interventions for maternal and child health and communicable and non-communicable diseases and mortality from 32 conditions amenable to health care. Progress is mixed; while Finland and Iceland have already achieved the 2030 target already, other countries, including in the Caucasus and Central Asia have not yet, and are unlikely to by 2030. We then examine financial protection, where progress lags in Central and South East Europe and the former Soviet Union, where high out-of-pocket healthcare payments and catastrophic spending are still common. We stress the need to consider inequalities within countries, with the most vulnerable groups, such as Roma or newly arrived migrants (from the Middle East and Africa) often underserved, while their needs are frequently undocumented. To make progress on the SDGs, governments must invest more heavily in health services research and support the infrastructure and capacity required to enable it.
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Kohi, Thecla W., Lucy Makoae, Maureen Chirwa, William L. Holzemer, Deliwe RenéPhetlhu, Leana Uys, Joanne Naidoo, Priscilla S. Dlamini, and Minrie Greeff. "HIV and AIDS Stigma Violates Human Rights in Five African Countries." Nursing Ethics 13, no. 4 (July 2006): 404–15. http://dx.doi.org/10.1191/0969733006ne865oa.
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The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo™ software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people.
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Madiba, Sphiwe, and Ntaoleng Mohlabane. "Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho." AIMS Public Health 8, no. 3 (2021): 541–52. http://dx.doi.org/10.3934/publichealth.2021044.
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<abstract><sec> <title>Background</title> <p>To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.</p> </sec><sec> <title>Methods</title> <p>In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.</p> </sec><sec> <title>Results</title> <p>The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.</p> </sec><sec> <title>Conclusion</title> <p>A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.</p> </sec></abstract>
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Ellis, Nicola, Ellie Walker-Todd, and Catherine Heffernan. "Influences on childhood immunisation decision-making in London's Gypsy and Traveller communities." British Journal of Nursing 29, no. 14 (July 23, 2020): 822–26. http://dx.doi.org/10.12968/bjon.2020.29.14.822.
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Aims: Uptake of childhood immunisations is lower among Gypsy, Roma and Traveller (GRT) communities than in the general UK population. This small-scale study aimed to elicit insights from GRT mothers on their interaction with health services in London around childhood immunisations. The purpose was to inform a larger piece of work by the NHS England and Improvement (London) Public Health Commissioning Team to inform their planning to improve access to vaccination services for GRT communities in London. Study design: An exploratory qualitative study using semi-structured interviews and a focus group. Methods: There was purposive sampling of mothers from any GRT background from south-west London using snowballing methods. One focus group and three interviews were conducted. A thematic analysis approach was used. Results: A total of nine women were recruited and seven participated between March and April 2018. Five themes were identified: adherence with antenatal care, self-declared parenting expertise, family support, childhood immunisations, keep children healthy but ‘they say wait on the MMR until they are talking’. Conclusion: Compliance with antenatal care, strong parenting beliefs and cohesive family support are strong influences on decision-making regarding immunisations. The women interviewed emphasised their own expertise in child rearing. This was occasionally at odds with the health advice provided by health professionals. The women widely shared their experiences of health professionals with other family and community members and this impacted on others' intention to vaccinate. These are key issues that should be considered when trying to improve uptake of immunisations in GRT families in a face-to-face manner. Equally, it warrants further exploration in a larger-scale study to see whether this reflects the wider community and in order to tailor supplementary immunisation activities to improve uptake.
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Chiarenza, Antonio, Lidia Horvat, Katja Lanting, Anna Ciannameo, and Jeanine Suurmond. "Addressing healthcare for migrants and ethnic minorities in Europe: A review of training programmes." Health Education Journal 78, no. 1 (August 18, 2018): 9–23. http://dx.doi.org/10.1177/0017896918793164.
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Background: The global phenomenon of migration has dramatically changed the social context in which healthcare professionals operate. European states are facing a growing need to effectively train healthcare professionals to understand and respond appropriately to the diverse needs of migrants and ethnic minorities. While many European Union (EU) countries have adopted specific initiatives, there is considerable variation in these activities and few examples of evaluation of the quality of these training courses. Aims: This article describes findings from a review conducted as a part of the ‘Training packages for health professionals to improve access and quality of health services for migrants and ethnic minorities, including the Roma (MEM-TP)’ project, which sought to identify and assess training programmes for health professionals delivered in Europe between 2004 and 2013. Methods: The review and analysis of training materials comprised three components: (1) a review of the published and unpublished literature, (2) a survey addressing national contact persons, and representatives of international organisations and non-governmental organisations and (3) an assessment of the quality of the training programmes identified. Results: The review showed that training programmes tend to be characterised by low levels of participant involvement in training development, delivery and evaluation. Training programmes often lacked an explicit pedagogical approach, did not systematically focus on outcomes in training design, implementation and evaluation, and were poorly linked to key organisational and policy support. Finally, while cultural competence continues to be the broad conceptual approach used in training programmes, alternate approaches such as intersectionality, equity and person-centred care are emergent. Conclusion: Training programmes in Europe can be further improved in order to ensure an effective response to the diverse needs of patients, carers, health professionals and the community.
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Ayeni, Philips O., Blessed O. Agbaje, and Maria Tippler. "A Systematic Review of Library Services Provision in Response to COVID-19 Pandemic." Evidence Based Library and Information Practice 16, no. 3 (September 15, 2021): 67–104. http://dx.doi.org/10.18438/eblip29902.
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Objective – Libraries have had to temporarily shut their doors because of the COVID-19 pandemic, resulting in the provision of online and remote services. This review analyzed services offered by libraries, the technological tools used, and the challenges facing libraries during the pandemic. Methods – This study employed a systematic literature review, following the PRISMA checklist (Moher at al., 2009). The Building Blocks search strategy was employed to search for keywords of concepts in Library and Information Science Abstract (LISA), Library and Information Science Technology Abstract (LISTA), Library Science Database, Web of Science (WoS) core collections, and Google Scholar. A set of inclusion and exclusion criteria was pre-determined by the authors prior to database searching. Quality assessment of included studies was performed using the Mixed Methods Appraisal Tool (Hong et al., 2018). A tabular approach was used to provide a summary of each article allowing the synthesis of results, which led to the identification of eight broad categories of services provided by libraries in included studies. Results – The first set of searches from the 5 databases produced 3,499 results. After we removed duplicates and applied the inclusion and exclusion criteria based on titles and abstracts, 37 potentially relevant articles were identified. Further screening of the full-text led to the final inclusion of 23 articles used for the qualitative synthesis. The majority of the studies were conducted in the United States of America (n= 6, 26.1%), followed by India (n=4, 17%), and China (n=2, 8.7%). The remaining studies were carried out in United Kingdom, Ireland, Canada, Mexico, Romania, Czech Republic, Indonesia, Pakistan, Nigeria, Lesotho, and Zimbabwe. The most common method used in selected studies was the case study (n= 11, 48%), followed by survey (n=7, 30.4%), content analysis (n=4, 17.4%), and mixed methods (n=1, 4.3%). The majority of the studies were carried out in academic libraries (74%), while the rest were based on medical, public, and special libraries. Findings show that the majority of academic libraries in the included studies are providing and expanding access to electronic resources (n=16, 69.6%) and increasing open access resources and services (n=11, 47.8%). More so, most academic libraries are assisting in virtual education and teaching endeavors of faculty and students (n=13, 56.5%). In addition, some medical and public libraries are bolstering public health safety through health literacy (n=12, 52.2%), supporting research efforts, and engaging in virtual reference services, among others. In order to carry out these services, libraries are harnessing several educational, social networking, communication, and makerspaces technologies. Most of the libraries in the included studies reported budgetary challenges, and the need for new ICT infrastructure and Internet service as they move their services online. Conclusion – This review found that libraries are adapting in a number of ways to continue their roles in meeting patrons’ needs in spite of the growing challenges posed by COVID-19 restrictions and lockdown. For libraries to thrive in these trying times, there must be a well-structured approach to ensuring continuity of services. Libraries should prioritize the acquisition of electronic resources as well as increase their efforts to digitize resources that are only available in printed copies. As library services have predominantly shifted online, there should be concerted effort and support from government and funding agencies to equip libraries with the technological facilities needed to provide cutting-edge services. The quality assessment of the included studies shows that there is need for rigor and transparency in the methodological description of studies investigating library services provision in a pandemic. This review provides an overview of the ways libraries have responded to the challenges posed by a global pandemic, and hence will be of use and interest to all librarians especially those in health and academic sectors.
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Dokupilová, Dušana, Vladimír Baláž, Vladimíra Čavojová Kurincová, Eva Ballová Mikušková, and Dagmar Gombitová. "Identifying major policy challenges and policy interventions via expert methods." Review of Economic Perspectives 20, no. 3 (September 1, 2020): 361–77. http://dx.doi.org/10.2478/revecp-2020-0017.
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AbstractThis paper presents the application of expert decision methods for the formulation and prioritization of the long-term economic, social and environmental policies in the Slovak Republic. The Partnership Agreement for the Slovak Republic (PA) is an underlying strategy for investments from the European Structural and Investment Funds (ESIF) in the period 2021-2027. Policies implemented under the PA will allocate €13.4b on four policy objectives. This paper concentrates on the policy objective 4 ‘Social development’. The authors co-operated with the Deputy Prime Minister Office and assembled panels of top Slovak experts on social and economic issues. The Delphi and Analytical hierarchy process (AHP) methods were combined for analyzing major development challenges and eliciting policy priorities. The methods combined the bottom-up and top-down approaches to policy making. Nine potential policy measures in three policy areas emerged from the Delphi exercise. The AHP exercise applied three criteria (relevance, urgency and feasibility) to rank the abovementioned measures within three policy areas. As for the Policy Area 1 (Labour market, employment, training and institutions) the measure 4.1.1 ‘Improving access to employment and modernizing institutions and services on labour market’ clearly dominated over the measure 4.1.2 ‘Supporting a better work-life balance’. The measure 4.2.2 ‘Equal access to quality and inclusive education’ emerged substantially more important than measures 4.2.1 ‘Improving the quality and effectiveness of education and training systems’ and 4.2.3 ‘Support to life-long learning’ in the Policy Area 2 ‘Education and skills’. Finally, measures 4.3.2 ‘Supporting social and economic integration of marginalized Roma communities’ and 4.3.3 ‘Ensuring equal access to healthcare including primary care’ received the highest ranks in the Policy Area 3 ‘Health and social services’.
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Pantelic, Marija, Janina I. Steinert, Jay Park, Shaun Mellors, and Fungai Murau. "‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV." BMJ Global Health 4, no. 2 (March 2019): e001285. http://dx.doi.org/10.1136/bmjgh-2018-001285.
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BackgroundSelf-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries.MethodsStudies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines.ResultsOf 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects.ConclusionStructural interventions such as scale-up of antiretroviral treatment, prevention of medication stockouts, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma.
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Muntingh, Lukas M. "Africa, Prisons and COVID-19." Journal of Human Rights Practice 12, no. 2 (July 2020): 284–92. http://dx.doi.org/10.1093/jhuman/huaa031.
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Abstract Africa’s prisons are a long-standing concern for rights defenders given the prevalence of rights abuses, overcrowding, poor conditions of detention and the extent to which the criminal justice system is used to target the poor. The paper surveys 24 southern and east African countries within the context of COVID-19. Between 5 March and 15 April 2020 COVID-19 had spread to 23 southern and east African countries, except Lesotho. The overwhelming majority of these countries imposed general restrictions on their populations from March 2020 and nearly all restricted visits to prisons to prevent the spread of the coronavirus. The pandemic and government responses demonstrated the importance of reliable and up to date data on the prison population, and any confined population, as it became evident that such information is sorely lacking. The World Health Organization recommended the release of prisoners to ease congestion, a step supported by the UN Subcommittee on Prevention of Torture. However, the lack of data and the particular African context pose some questions about the desirability of such a move. The curtailment of prison visits by external persons also did away with independent oversight even in states parties to the Optional Protocol to the Convention against Torture (OPCAT). In the case of South Africa, prison monitors were not listed in the ensuing legislation as part of essential services and thus were excluded from access to prisons. In the case of Mozambique, it was funding being placed on hold by the donor community that prevented the Human Rights Commission from visiting prisons. The COVID-19 pandemic has highlighted long-standing systemic problems in Africa’s prisons. Yet African states have remained remarkably reluctant to engage in prison reform, despite the fact that poorly managed prisons pose a significant threat to general public health care.
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Kokoriev, Oleksii. "Tolerance vs intolerance: Latvia's case as an expression of value and institutional ambivalence." Bulletin of Mariupol State University. Series: History. Political Studies 10, no. 27 (2020): 126–34. http://dx.doi.org/10.34079/2226-2830-2020-10-27-126-134.
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The article examines Latvia's compliance with the EU's institutional and value strategy for promoting the principle of tolerance. The main manifestations of intolerance in the social and political life of Latvia as a "young" democracy are investigated. The legal gaps, the peculiarities of the political and legal culture of the population and other factors that cause intolerance in Latvia, despite this country's 2004 membership in the EU, have been emphasized. Institutional reforms aimed at strengthening the value of tolerance and preventing destructive intolerant practices are analysed. Providing tolerance for Latvia is called a challenge for this country. It was stressed that countering intolerance remains an important component of the country's still unfinished post- socialist democratization. Attention is paid to maintaining a high percentage of non-citizens in the population structure of Latvia. It is emphasized that in Latvia there is the highest level of sexual minority intolerance in the Baltic countries group, especially the expressed intolerance towards transgender and intersex people. It is noted that the legislation of Latvia is not yet fully consistent with the European Commission's General Policy Recommendation against Racism and Intolerance No. 7 in the fight against racism and racial discrimination. Attention is drawn to the lack of special services in law enforcement agencies to assist victims of hate speech. It has been stated that there is a lack of promotion of counter-speech in response to racist, homo- / transphobic hate speech on the part of high-ranking officials and public activists. This contributes to the fact that those who resort to hate speech do not feel public condemnation and increase their destructive presence in Latvia. Attention was drawn to the problem of preserving the marginalization of Roma, especially in the area of employment, provision of public health and education services. The article states that there are manifestations of anti-Semitism in Latvia, especially in Internet discourse. It is noted that despite the small number of refugees received in recent years by Latvia, there is a high level of intolerance of asylum seekers. At the same time, public opinion is often formed precisely because of the destructive public rhetoric of Latvian politicians. The general problem of Latvia is the high tolerance for violence in general – at home, at school, against certain social groups, etc. It is indicated that in this country there is a high tolerance for various destructive unlawful practices, such as involvement in the shadow economy, the purchase of smuggled goods, and so on. The author of the article argues that the reasons for the mentioned problems of Latvia are not least in the plane of the political and legal culture of the Latvians, in which the intolerance to diversity and the neoliberal-democratic values, on which the EU is oriented, are still quite strong.
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Eshun-Wilson, Ingrid, Ajibola A. Awotiwon, Ashley Germann, Sophia A. Amankwaa, Nathan Ford, Sheree Schwartz, Stefan Baral, and Elvin H. Geng. "Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis." PLOS Medicine 18, no. 5 (May 28, 2021): e1003646. http://dx.doi.org/10.1371/journal.pmed.1003646.
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Background Antiretroviral therapy (ART) initiation in the community and outside of a traditional health facility has the potential to improve linkage to ART, decongest health facilities, and minimize structural barriers to attending HIV services among people living with HIV (PLWH). We conducted a systematic review and meta-analysis to determine the effect of offering ART initiation in the community on HIV treatment outcomes. Methods and findings We searched databases between 1 January 2013 and 22 February 2021 to identify randomized controlled trials (RCTs) and observational studies that compared offering ART initiation in a community setting to offering ART initiation in a traditional health facility or alternative community setting. We assessed risk of bias, reporting of implementation outcomes, and real-world relevance and used Mantel–Haenszel methods to generate pooled risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals. We evaluated heterogeneity qualitatively and quantitatively and used GRADE to evaluate overall evidence certainty. Searches yielded 4,035 records, resulting in 8 included studies—4 RCTs and 4 observational studies—conducted in Lesotho, South Africa, Nigeria, Uganda, Malawi, Tanzania, and Haiti—a total of 11,196 PLWH. Five studies were conducted in general HIV populations, 2 in key populations, and 1 in adolescents. Community ART initiation strategies included community-based HIV testing coupled with ART initiation at home or at community venues; 5 studies maintained ART refills in the community, and 4 provided refills at the health facility. All studies were pragmatic, but in most cases provided additional resources. Few studies reported on implementation outcomes. All studies showed higher ART uptake in community initiation arms compared to facility initiation and refill arms (standard of care) (RR 1.73, 95% CI 1.22 to 2.45; RD 30%, 95% CI 10% to 50%; 5 studies). Retention (RR 1.43, 95% CI 1.32 to 1.54; RD 19%, 95% CI 11% to 28%; 4 studies) and viral suppression (RR 1.31, 95% CI 1.15 to 1.49; RD 15%, 95% CI 10% to 21%; 3 studies) at 12 months were also higher in the community-based ART initiation arms. Improved uptake, retention, and viral suppression with community ART initiation were seen across population subgroups—including men, adolescents, and key populations. One study reported no difference in retention and viral suppression at 2 years. There were limited data on adherence and mortality. Social harms and adverse events appeared to be minimal and similar between community ART initiation and standard of care. One study compared ART refill strategies following community ART initiation (community versus facility refills) and found no difference in viral suppression (RD −7%, 95% CI −19% to 6%) or retention at 12 months (RD −12%, 95% CI −23% to 0.3%). This systematic review was limited by few studies for inclusion, poor-quality observational data, and short-term outcomes. Conclusions Based on data from a limited set of studies, community ART initiation appears to result in higher ART uptake, retention, and viral suppression at 1 year compared to facility-based ART initiation. Implementation on a wider scale necessitates broader exploration of costs, logistics, and acceptability by providers and PLWH to ensure that these effects are reproducible when delivered at scale, in different contexts, and over time.
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Jankielsohn, Roy, and Rami Zahrawi Haj-Younes. "Ideology based incapacity on hydropolitics in South Africa Sudáfrica: an ontological assessment." Relaciones Internacionales, no. 45 (October 31, 2020): 289–304. http://dx.doi.org/10.15366/relacionesinternacionales2020.45.013.
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The Covid-19 pandemic has highlighted the importance of hydropolitics in South Africa. The country remains one of the driest countries in the world with a below average rainfall of 450 mm per annum. The country’s economic hub in the Gauteng province is largely dependent on water from the neighbouring Kingdom of Lesotho. On a geopolitical level the country also shares various water sources with neighbouring states. This is especially relevant due to the dependence on South Africa, as the regional hegemon, for access to markets and income. However, large areas of South Africa experience extreme water scarcity due to a combination of factors that include climate change related drought, urbanisation and government-related water management failures. In many local government municipalities across the country the lack of government capacity to supply water resources and manage waste water have reached crisis proportions. Many towns and communities across South Africa have been left with unreliable access to sustainable water resources. This is mainly due to a combination of corruption, poor management and the lack of institutional capacity at local government level. The institutional incapacity of government is a result of the governing party African National Congress’ ideological approach to government, combined with political factionalism, which has stripped the civil service of expertise and led to the exodus of skilled individuals from both government and the country. The government’s implementation of the communist ? based Leninist democratic centralism, commonly known as a cadre deployment strategy, has resulted in large scale state capture and corruption that has had a devastating impact on the delivery of basic services such as water. Hydropolitical civil unrest has increased to an extent that, in instances such as the Majakeng and Maluti-a-Phofung municipalities, unrest became extremely violent and disrupted businesses and well as state education and health facilities. This article is an ontological investigation into the hydropolitical impact of, and ideological reasons for, state incapacity to manage water resources and deliver safe and sustainable supply of water to the population. While reference will be made to the general situation in the country, the Majakeng and Maluti-a-Phofung municipalities will be used as a case studies for the impact of water insecurity on political stability. On the other hand, the City of Cape Town’s ability to manage water scarcity and avert a drought related “day zero” scenario is used as an example of what can be achieved through sound management. The article will combine ideological considerations with theoretical explanations of ideology and state failure within a hydropolitical context in order to explain the current water crisis at local government level in South Africa and the threat that this poses to the political order in the country. Being a regional hegemon, any political disruptions in South Africa also threaten the geopolitical stability of the entire Southern African region. There remains a great deal of scope for future geopolitical co-operation around water within the Southern African Development Community that can secure a sustainable sources of future water supplies for South Africa and generate further income for the country’s neighbours. The article evaluates the current water situation in the country, explains the water related geopolitical considerations that the country has to take into account, investigates the ideological basis for government policy and institutional strategy and the impact that this has on the capacity of the state to deliver sustainable and reliable water access to local communities, and then evaluates some case studies that include both failures and a success story. This assessment includes various sources of literature that supply a theoretical conceptual basis for terms such as hydropolitics and ideology. These academic concepts provide the basis for the practical considerations that are an integral part of the ideologically ? based hydropolitical ontological assessment. The article concludes with some broad recommendations on how the country could mitigate some of the hydropolitical challenges that it faces.
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Obioha, Emeka E. "Functioning and Challenges of Primary Health Care (PHC) Program in Roma Valley, Lesotho." STUDIES ON ETHNO-MEDICINE 05, no. 02 (August 8, 2011). http://dx.doi.org/10.31901/24566772.2011/05.02.01.
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Seutloali, Thato, Lizeka Napoles, and Nomonde Bam. "Community health workers in Lesotho: Experiences of health promotion activities." African Journal of Primary Health Care & Family Medicine 10, no. 1 (February 27, 2018). http://dx.doi.org/10.4102/phcfm.v10i1.1558.
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Background: Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care.Aim: The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho.Setting: The study was conducted in four health centres in Berea district, Lesotho.Methods: A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses.Results: The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement.Conclusion: This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention.