Wednesday, 22 October 2014

Journal of Peasant Studies new special issue: critical perspectives on Food Sovereignty

A new special issue on ‘Critical perspectives on food sovereignty’ from the Journal of Peasant Studies has been released, with free articles available for a limited period. The guest editors are Marc Edelman, James C. Scott, Amita Baviskar, Saturnino M. Borras Jr., Deniz Kandiyoti, Eric Holt-Gimenez, Tony Weis and Wendy Wolford.

The issue is volume 2 in a series on Global Agrarian Transformations (Volume 1 is also still accessible for free from the Taylor and Francis website).

As JPS’s contribution to the ongoing food sovereignty debate, the journal is also making available for free for a limited time three commentary articles:

Minimising delays for maternal health seeking in Uganda through saving schemes

The Challenge
When Mrs X (real name withheld) went to her local health centre in one of our intervention districts for a final check-up just one month before her expected due date, she never anticipated what the midwife told her. She was told to make plans to deliver at the health centre or a general hospital because there was a likelihood of her delivery being complicated.

Mrs X had an unusually large baby and needed to deliver in a health facility where caesarean section could easily be offered in time if the need arose. Sadly Mrs X had not saved for the anticipated expenses in form of transport fares, upkeep and the surgery. By the time Mrs X went into labour, her family could hardly raise the transport fare and by the time her husband got the money, a traditional birth attendant had been called in and was failing to help. Mrs X and the baby were lost a few metres from the hospital!

Without any kind of savings in the house to cater for transport Mrs X's family delayed reaching care. The family of Mrs X is not in isolation. There are many more like it.

Our Intervention
Households and individual community members are being educated and encouraged to join or start financial social networks, like saving groups, which offer financial protection. In addition to the business funds, the networks are advised to have a separate fund to cater for maternal and newborn health needs. Members can access these funds to cater for emergency transport to and from the health facility for pregnant women, mothers and newborns. The fund is also meant to provide funds to cater for birth items. Saving groups are similarly encouraged to enter into partnership with transporters.
At inception of the study in 2013, 816 existing groups of all manner and 795 transporters (boda boda drivers) were oriented on the new initiative.

Initial Success
Twambagane Saving Group is one of the groups that has been established in Kamuli district as a result of the orientation and training. With 34 members — 26 women and 8 men — the leader Godfrey Kisubi, who is also a CHW, says membership is closed. His strategy is to encourage groups with manageable numbers that only open up to more members after gaining experience.

Group member Miriam Kisakye is very proud and happy to be part of the initiative. "When the labour started we did not have readily available funds for transport to hospital but our savings in the group came in handy. Let those who have not started such groups act immediately because they are very beneficial," says Miriam who had given birth just two weeks prior to our visit.

There is good news in Pallisa as well, as Betty Opolot, the leader of Puti Puti Central Saving Group explains:
"I attended training organized by MANIFEST. After the training, we organized the women and talked to them about the issues related to maternal and newborns and the reasons why we need to save money specifically for maternal and newborn emergencies. 21 women managed to join the group. The saving group started this year (2014) and so far we have saved 500,000 Uganda shillings [. So far one woman has accessed the funds to cater for her transport needs to the hospital."
If this momentum is not lost, it is believed that the cases of Mrs. X will be greatly reduced. As at end of August 2014, a total of 1260 groups had an MCH (maternal and child health) fund.

By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer

[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]

Melissa Leach on Ebola & inequality – lecture text & audio

Some materials are now available from the recent Sussex Development Lecture on Equality, Sustainability, Security: Interlaced challenges in a global development era by former STEPS Director Melissa Leach. The text is available to download below as a PDF, and you can listen to Melissa's lecture online, courtesy of the Institute of Development Studies.

In the lecture, Melissa uses Ebola as a lens to look at how inequalities, unsustainability and insecurity can interact, enhanced by misguided interventions, to render people and places deeply vulnerable. Addressing these interactions must become central to a renewed vision of development for all.

Further reading
Ebola: difficult questions for development blogpost by Ian Scoones, 13 October 2014
Our resources on Ebola and other animal-to-human diseases

Tuesday, 21 October 2014

Community health workers encourage women in Uganda to seek skilled care early in pregnancy

The challenge
Deciding to seek care from a skilled health worker by a woman at the time of delivery is highly encouraged in order to improve health outcomes for both mother and baby. When a woman delivers under skilled care, it is easier to detect and attend to any emergences that arise. However in Uganda, 42 per cent of the estimated 1.2 million women who conceive every year do not deliver under skilled care. Some of the drivers of this sad state of affairs include: poor understanding of complications and risk factors in pregnancy and of when emergency medical interventions are necessary; previous unfortunate experiences of health care services; and acceptance of maternal death as something normal in many communities.

Our Intervention
Still under the community mobilisation and sensitisation component of the study, around 1,691 community health workers (CHWs, also known as village health teams or VHTs), were trained across the three study districts of Kamuli, Pallisa and Kibuku. The training focused on early detection of emergencies, birth preparedness and care for mothers who just delivered and their newborns. During the visits, CHWs provide households with information needed to ensure mothers have a safe delivery and remain healthy with their babies. Two home visits happen during pregnancy and two after delivery.

Initial Success
Ms Grace Asio is a mother of five with her youngest child delivered in early 2014. A mother of five, Grace has conceived seven times since getting married, but lost two pregnancies. She attributes that loss to a failure to appreciate the danger signs and to seek medical care in time.

"On both occasions I bled to near death and would get to hospital late. But all this happened because I did not know that bleeding was a danger sign. But now I can at least tell what the danger signs are during pregnancy. Upon detecting any I quickly tell my husband and we find ways of going to the health centre as fast as possible."

Mr Francis Kedi is the CHW for Okisiran central village in Akisim sub-county of Pallisa district, where Grace resides. Grace has nothing but praise for him. According to Francis, it was not easy "to get into some homes initially because the men thought we were going in to use their families as bait for some personal economic gains."

He adds: "We persisted and explained that what we were doing was for their good and many came on board save for a few perennial drunkards."

Beaming with pride, Francis further intimates that he is increasingly seeing the women he has visited seeking care in time whenever they suspect a problem with the pregnancy, and opting to deliver from health facilities. Francis has visited 65 homes with pregnant women in the last year.
And the outcomes are not any different from Grace's.

A total of 35,108 home visits had been made by the end of August 2014 across the three districts.The home visits by the CHWs who are always armed with flipbooks and demonstration mama kits are enabling women and families prepare better for birth and make informed timely decisions.

By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer

[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]

Tackling negative social cultural norms in Uganda through community dialogues and radio

The Challenge
Having knowledge of obstetric danger signs and embracing good birth preparedness practices could enhance maternal and newborn health outcomes. For example, a woman, working with her family, can choose her preferred birth location; choose her preferred birth attendant and make advance arrangements with that provider; make advance arrangements for transport to the skilled care site; obtain basic safe birth supplies; and save or arrange alternative funds for costs of skilled and emergency care.

However, in many Ugandan households, especially in rural areas, it is taboo to make these preparations. As a result, by the time of delivery, many are stuck in a reactive mode, which has sometimes led to death of either the mother or newborn, and sometimes both.


Our Intervention
Through the use of communications and media advocacy, the intervention study is tackling social and cultural issues that affect maternal and newborn health negatively. We are using village-level dialogues (once every three months) and radio talk shows (monthly) as well as spot messages (daily). The dialogues and talk shows offer a platform for discussing these issues and rally community suggestions and participation in addressing them. This community involvement promotes ownership and sustainability of behavioral changes. The dialogues are also expected to provide peer influence in favour of healthy maternal and newborn practices. And as convenors of the dialogues, village health teams (VHTs) have shared vital knowledge that is slowly changing the negative attitudes towards birth preparedness.


Initial Success
During the dialogues, women and men shared sad memories of maternal and newborn illness and death, underlining the grim reality of the situation. They also discussed good and bad practices and made commitments to abandon negative practices and therefore improve maternal and newborn health.

"I resolve to stop putting cow dung and other dangerous things on the cord of newborns. After today's talk I realise why my baby's cord took that long to heal. I urge fellow women to join a new me," said Ms Nabirye at a dialogue in Kamuli to thunderous applause from fellow women.

Monitoring data shows that, while only 17 per cent of sampled women who had just given birth treated cords with nothing but the appropriate saline water in mid-2013, that percentage had shot to 56% in mid-2014.

Mr Francis Kedi, a CHW in Pallisa says he has observed that more families are now appreciating delivery under skilled care, a view backed by monitoring data. In mid-2013, deliveries in health facilities in the three districts stood at 66%. As of May 2014, that
number had jumped to 84 per cent.

As at the end of August 2014, a total of 73,429 persons had attended the meetings. And if one of the goals of dialogue is to find common ground and find better solutions, then this is starting to manifest itself in the context of maternal and newborn health in the districts of Kamuli, Pallisa and Kibuku.

By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer

[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]