The Institute for Global Health and Development
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Item Border parasites: Schistosomiasis control among Uganda’s fisherfolk(Taylor & Francis, 2012-04-13) Parker, Melissa; Allen, Tim; Pearson, Georgina; Peach, Nichola; Flynn, Rachel; Rees, NicholasIt is recognized that the control of schistosomisais in Uganda requires a focus on fisherfolk. Large numbers suffer from this water-borne parasitic disease; notably along the shores of lakes Albert and Victoria and along the River Nile. Since 2004, a policy has been adopted of providing drugs, free of charge, to all those at risk. The strategy has been reported to be successful, but closer investigation reveals serious problems. This paper draws upon long-term research undertaken at three locations in northwestern and southeastern Uganda. It highlights consequences of not engaging with the day to day realities of fisherfolk livelihoods; attributable, in part, to the fact that so many fisherfolk live and work in places located at the country’s international borders, and to a related tendency to treat them as ‘‘feckless’’ and ‘‘ungovernable’’. Endeavours to roll out treatment end up being haphazard, erratic and location-specific. In some places, concerted efforts have been made to treat fisherfolk; but there is no effective monitoring, and it is difficult to gauge what proportion have actually swallowed the tablets. In other places, fisherfolk are, in practice, largely ignored, or are actively harassed in ways that make treatment almost impossible. At all sites, the current reliance upon resident ‘‘community’’ drug distributors or staff based at static clinics and schools was found to be flawed.Item Making a livelihood at the fish-landing site: Exploring the pursuit of economic independence amongst Ugandan women(Taylor & Francis, 2013-09-26) Pearson, Georgina; Barratt, Caroline; Seeley, Janet; Ssetaala, Ali; Nabbagala, Georgina; Asiki, GershimQualitative life history data were used to explore the experiences of women who live at five fish-landing sites on Lake Victoria, Uganda. We explored what economic and social opportunities women have in order to try to understand why some women are more vulnerable to violence and other risks than others and why some women are able to create successful enterprises while others struggle to make a living. The ability of women to create a viable livelihood at the landing sites was influenced by a wide variety of factors. Women who had or were able to access capital when they arrived at the landing site to set up their own enterprise had a significant advantage over those who did not, particularly in avoiding establishing sexual relationships in order to get support. Being able to establish their own business enabled women to avoid lower paid and more risky work such as fish processing and selling or working in bars. The development of landing sites and the leisure industry may be having an impact on how women earn money at the landing sites, with the most desirable economic opportunities not necessarily being connected directly to fishing.Item (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo(BioMed Central, 2019-01-31) Witter, Sophie; Bertone, Maria Paola; Namakula, Justine; Chandiwana, Pamela; Chirwa, Yotamu; Ssennyonjo, Aloysius; Ssengooba, FreddieBackground - Results-Based Financing (RBF) has proliferated in health sectors of low and middle income countries, especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing in these settings. This article examines the effects of several RBF programmes on health care purchasing functions in three fragile and post-conflict settings: Uganda, Zimbabwe and the Democratic Republic of Congo (DRC) over the past decade.Item Health workers' perceptions of private-not-for-profit health facilities' organizational culture and its influence on retention in Uganda(BioMed Central, 2017-12-06) Shumba, Constance Sibongile; Kielmann, Karina; Witter, SophieBackground: An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs ' working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention. Methods: Thirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi- structured topic guide. Interview transcripts were analysed using thematic content analysis. Results: Interviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management. Conclusions: The findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.Item Local constructions of gender-based violence amongst IDPs in northern Uganda: analysis of archival data collected using a gender- and age-segmented participatory ranking methodology.(BMC, 2018-02-07) Ager, Alastair; Bancroft, Carolyn; Berger, Elizabeth; Stark, LindsayGender-based violence (GBV) is a significant problem in conflict-affected settings. Understanding local constructions of such violence is crucial to developing preventive and responsive interventions to address this issue. This study reports on a secondary analysis of archived data collected as part of formative qualitative work - using a group participatory ranking methodology (PRM) - informing research on the prevalence of GBV amongst IDPs in northern Uganda in 2006. Sixty-four PRM group discussions were held with women, with men, with girls (aged 14 to 18years), and with boys (aged 14 to 18years) selected on a randomized basis across four internally displaced persons (IDP) camps in Lira District. Discussions elicited problems facing women in the camps, and - through structured participatory methods - consensus ranking of their importance and narrative accounts explaining these judgments. Amongst forms of GBV faced by women, rape was ranked as the greatest concern amongst participants (with a mean problem rank of 3.4), followed by marital rape (mean problem rank of 4.5) and intimate partner violence (mean problem rank of 4.9). Girls ranked all forms of GBV as higher priority concerns than other participants. Discussions indicated that these forms of GBV were generally considered normalized within the camp. Gender roles and power, economic deprivation, and physical and social characteristics of the camp setting emerged as key explanatory factors in accounts of GBV prevalence, although these played out in different ways with respect to differing forms of violence. All groups acknowledged GBV to represent a significant threat - among other major concerns such as transportation, water, shelter, food and security - for women residing in the camps. Given evidence of the significantly higher risk in the camp of intimate partner violence and marital rape, the relative prominence of the issue of rape in all rankings suggests normalization of violence within the home. Programs targeting reduction in GBV need to address community-identified root causes such as economic deprivation and social norms related to gender roles. More generally, PRM appears to offer an efficient means of identifying local constructions of prevailing challenges in a manner that can inform programming.Item Health service quality and users' perceptions in West Nile, Uganda(Wiley InterScience, 2004-04) Witter, Sophie; Osiga, G.Save the Children (UK) has been working in health in the West Nile region of Uganda since 1980. Between 2000 and 2002, a number of operational research studies have been conducted which shed light on patient perceptions of the quality of services, of barriers to access and utilization patterns. These are brought together in this paper. They show that despite considerable progress in rebuilding infrastructure, training staff and investing in health systems in these districts, there is still a long way to go to provide services of an acceptable quality to users.