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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7193

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Start date: 2001End date: 2009

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Now showing 1 - 6 of 6
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    Responding to the health needs of the internally displaced persons: an analysis of the Indonesian health system
    (Queen Margaret University, 2008) Massie, R.
    Since 1998, several provinces in Indonesia have suffered a number of violent conflicts causing massive destruction, several thousand deaths and creating over a million displaced people. This happened in North Maluku and Central Kalimantan Provinces. In 1999 the displaced people from North Maluku took flight to Manado municipality and in 2001 those from Central Kalimantan fled to Sampang District. These recipient areas were selected for this study because of their differing characteristics, including presence of IDPs; urban/rural; and levels of development. While the central government was initially responsible for providing adequate support in the first two -three years of their displacement in both areas, this changed at the end of 2003 when the central government terminated their support for the IDPs. During this period, authority for developing health programmes and services had been devolved to local government by central government through the health decentralisation policy in 2001, which created additional challenges to their meeting the needs of the incoming IDP population and particularly after the removal of government support for IDPs in 2003. This research was designed to contribute to a policy or model to be developed by the Indonesian health authorities to provide services for IDPs. The research questions were: what are the key health needs of the displaced population in the two selected recipient areas in Indonesia; what are the problems experienced by services in the municipality and district in seeking to meet these needs; to what extent has the public sector identified and responded to the health needs of the IDPs in the context of the health decentralisation policy that was currently being implemented in these two areas; on the basis of the preceding analysis, what are appropriate recommendations for the provision of health services to the displaced populations of Indonesia? The research employed mixed methods in handling the above questions. It was conducted through direct observation, surveys and focus group discussions (FGD) with IDPs. Semi-structured interviews were conducted with the Heads of the Municipal/District Health Offices and Heads of selected puskesmas in the recipient IDP areas. Respondents for surveys were selected by using a formula for estimating statistical proportions. 71 respondents in Manado and 116 respondents in Sampang were selected and respondents for FGD were selected through purposive sampling. This thesis presents the effect of the reception of IDPs on the local health systems and the responses of the areas that received them. It argues that IDPs, trapped in complex emergency situations with consequent increased health needs, added a burden to the health systems in the recipient areas The findings indicated that the local health authorities were unable to fully meet the health needs of the IDPs and therefore suggested that local health systems need to be improved at the same time as the implementation of the health decentralisation policy. This thesis provides recommendations for the public health sector capacity in the areas that received the IDPs. These are intended to enable the national health system to fill the gap between the health needs of the IDPs and the local authority health system. Recommendations include: redefinition of functions of local health institutions, ensuring a better quality of health service and strengthening the referral system.
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    Unfolding tragedies: the impact of a mother's death on her kin and community. An ethnography from Southern Malawi.
    (Queen Margaret University, 2003) Putter, C.
    In examining the specific impact of a mother's death on her surviving family and community, the thesis highlights the social devastation resulting from such an event. Crucially, it argues that the increased frequency of maternal death associated with the HIV/AIDS epidemic, and the associated increase in numbers of orphaned children, have the potential to provoke full-scale destruction of traditional kinship structures and coping mechanisms. The study contributes to a gendered study of death and the resultant coping mechanisms as well as emphasizing the importance of sibling bonds in Malawian kinship. Furthermore, it provides an analysis of the current trends relating to orphan care, and suggests how these goals could be improved within the specific cultural context. The findings are based on 14 months of in situ fieldwork, during which time a totla of 78 interviews were conducted with 66 individuals, 46 of whom are case studies. Further interviews were conducted with hospital personnel, workers with orphans, and teachers, i.e. those in positions to provide social commentary. Nudist N4 software was used for data management of the interview transcripts and fieldnotes, and facilitated access to the coded data as analysis proceeded. An historical understanding of Malawi's cultural context is outlined in the introductory chapter and the entire discussion is grounded within this context. More detailed anthropological data is provided in the chapter on kinship, which emphasizes the importance of maternal kin in looking after orphans subsequent to a mother's death. Chapters on HIV and death outline how communities are besieged by illnesses surrounding HIV-infection, and how the increased death rates associated with HIV have undermined the traditional bereavement processes, and, hence, the associated coping mechanisms. The thesis concludes with a discussion of the kinds of orphan care currently available in Malawi, followed by recommendations on how the needs of orphans could better be met by development initiatives that are more suited to working with community-based organizations.
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    Decentralisation in the post-conflict environment of Guatemala: a critical examination of the evaluation process of community participation in a health sector reform context
    (Queen Margaret University, 2007) De Leon Estrada, Mario Sergio
    This thesis focuses on a critical and comprehensive analysis of community participation within a health sector reform process in a post-conflict environment. The aim is to examine how evaluation of such processes should be guided, how decentralising policies should be implemented, and how the assumptions of existing evaluations limit their relevance and effectiveness. The thesis argues that comprehensive analysis demonstrates the need for a much deeper and more extensive understanding of the multiple complexities present in post-conflict environments than is often achieved. It is necessary to carry out a historical, comparative and analytical evaluative exercise, beyond mainstream structural-functionalist evaluations, because the latter generally do not address relevant external and internal variables affecting the conditions of the community. Utilising this proposed approach fieldwork in the communities of San Juan Chamelco and San Miguel Tucurú (in the northern department of Alta Verapaz) examined examples of the limitations of and potentials for the incorporation of traditional medicine into the institutional healthcare system. This fieldwork is used to inform development of a comprehensive framework for evaluation with wide potential as a technical-conceptual tool. The Guatemalan case is presented as an illustrative example of how this tool can be developed and elaborated within a specific historical, political, social and cultural context. Building on the findings of a sectoral evaluation carried out under the auspices of the Ministry of Health the comprehensive evaluation presented identifies key problems that prevented health decentralisation policies from having a significant and positive impact at the local level. In this complex post-conflict environment, local organisation and community participation are shown to be still in their infancy having been obliterated by the counter-insurgency policies during the course of prolonged conflict.
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    Alleviating psychosocial suffering: an analysis of approaches to coping with war-related distress in Angola.
    (Queen Margaret University, 2001) Eyber, Carola
    This study investigates the role that the notions of trauma and culture play in relation to the alleviation of distress within an war-affected population. It analyses how local, cultural conceptions of distress and those held by psychological service providers relate to one another, and how they contribute to improving the well-being of the displaced. Fieldwork was conducted with urban and rural displaced populations in the south-eastern province of Huila in Angola. Ethnographic, psychometric and participatory methods were used to examine issues of health, illness and distress amongst the displaced. Local idioms of distress in the form of pensamentos, mutima, madness and high and low blood pressure are common ways of expressing suffering related to war. The different explanatory models held about these illnesses and the various resources available in the popular, folk and professionals sectors of the health care system were explored. The religious and spiritual domains were found to be influential in the treatment of distress-related illnesses. The psychological services available in the war-displaced communities were examined in terms of their common theoretical and practical elements. These were then analysed in relation to the conceptualisations held by local populations, and points of similarity and difference were noted. Specifically, the conceptualisation of suffering as trauma and the cultural misunderstandings that arise as a result of this, and the representation of the displaced as traumatised and therefore dependent and passive people, are discussed. A particular subgroup in the community, the adolescents, was identified and participatory methods were employed to investigate the strategies and resources this group uses for coping with war-related distress. The youths predominantly make use of distraction, conselho, religious and cultural resources. The application of a PTSD scale, the EARAT, suggests that 71% of the adolescents had symptoms of trauma consistent with a diagnosis of PTSD. It is argued that for the vast majority such a conceptualisation does not reflect the adolescents' abilities to function on social, vocational, educational and physical levels. The implications of these findings for research and practice in the field of psychosocial work are discussed.
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    An assessment of the capacity of faculty-based youth friendly reproductive health services to promote sexual and reproductive health among unmarried adolescents: evidence from rural Malawi
    (Queen Margaret University, 2009) Jimmy-Gama, Dixon
    Despite the recognition of the influence of cultural norms on adolescent sexual behaviours in most societies (Kaler 2004; Chege 2005), less attention has been paid to the link between social norms and effectiveness of health facilities to promote adolescent sexual and reproductive health (ASRH). This thesis therefore examines the capacity of facilitybased youth-friendly reproductive health services (YFRHS) to promote ASRH in rural Malawian societies where culture strongly influences adolescent sexual behaviours. The study employs a social constructionist epistemology and a social interactionism theory to understand the capacity of YFRHS in ASRH promotion in rural Malawi. Qualitative and quantitative data were collected using a sequential exploratory design. Semi-structured in-depth interviews, participant observations, client exit interviews, survey, focus group discussions and review of health strategic and service utilisation documents/records were conducted. The results were generated by triangulating both qualitative and quantitative data. The findings of the study illuminate how social norms related to social identities influence adolescent sexual behaviours and ASRH promotion. An exploration of the cultural context reveals a major disjuncture between an ideal norm - no premarital sex - and a modelled norm where unmarried adolescents are expected to engage in unsafe sex. It also shows the conflicts between the cultural and scientific models of ASRH promotion. Structural gender asymmetry that emphasises subservience in females and hegemonic masculinity also reduces adolescents' rights and agency in SRH promotion. The health providers are cultural agents. They manage diverse roles both as 'moral guardians' and as 'health promoters' in a way that limits their effectiveness as health promoters. The thesis concludes that the way facility-based YFRHS is implemented has limited impact on SRH promotion among unmarried adolescents of rural Malawi. The study recommends that appropriate health promotion interventions based on conscientisationoriented empowerment theories directed at adolescents, community and health workers should be used in ASRH promotion in societies with strong cultural influence on sexual behaviours.
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    Rhetoric or reality? Cross-sector policy and practice at the UK Government Department for International Development (DFID) in the UK and Nepal: an exploration of reproductive health and women's education linkages
    (Queen Margaret University, 2005) Bovill, Catherine
    Within the international development community, global agreement around a poverty elimination target and the Millenium Development Goals (MDGs) has led to renewed emphasis on partnership and cross-sectoral approaches. Similarly the UK Government aims to ensure policies are coherent in an increasingly complex global arena and has called for joined-up working. In response to both of these influences, the UK Government Department for International Development (DFID) stresses partnership, joining-up and cross-sectoral approaches within departmental documents. This research explores cross-sector policy and practice at DFID in the UK and Nepal and focuses particularly on cross-sectoral relationships between reproductive health and women's education. The research employs a social constructionist epistemology and utilises Critical Inquiry and Feminist theories, elements of grounded theory and narrative analysis methodologies, informing the use of numerous data collection methods. These methods include literature searches, document analysis, semi-structured interviews (incorporating Participatory Learning and Action techniques), informal meetings and critical reflection. Data was gathered in the UK and Nepal from DFID staff, Nepali Government staff, DFID-funded project staff, external development consultants and other stakeholders. A 'cross-sector continuum model' is presented to facilitate understanding of the different definitions and possible levels of cross-sectoral engagement. Examples of cross-sector policy and practice are presented and discussed. Key factors facilitation cross-sector policy and practice are also identified. The greatest levels of cross-sectoral engagement were found at project-level in Nepal, although the DFID offices had also made some significant efforts to improve cross-sectoral approaches. Poor knowledge and selective use of the reproductive health and women's education research, however, exposed a gap between research and policy. In addition, the reality of cross-sector policy and practice often did not match the rhetoric within DFID's documents. According to respondents, DFID faces some substantial challenges that contribute to these research-to-policy and policy-to-implementation gaps. Despite the increased calls for cross-sectorality, there is little evidence of the benefits of cross-sector policy and practice, suggesting the need for research clarifying the added value of cross-sectoral approaches. Finally, the lack of agreement over cross-sector definitions, the lack of operational guidance and DFID's strong emphasis on outcomes all suggest the need for a reorientation of focus towards cross-sectoral processes. Based on these findings and conclusions, recommendations are made for DFID and other organisations wishing to pursue cross-sectoral approaches.