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AbstractStudies have demonstrated that health communication programmes, through community health workers or mass media, are a key strategy to promote awareness and uptake of essential maternal health services. This study investigated whether or not family planning communication through mass media and health workers has any association with maternal health care utilization uptake in Nigeria. Cross-sectional data were extracted from the 2003–13 Nigeria Demographic and Health Surveys. The study sample comprised 41,938 women aged 15–49 years who had a live birth during the 5 years preceding the survey. Outcome variables were adequacy of antenatal care visits and place of delivery. Receiving family planning messages from the radio, TV, newspapers, a family planning worker or during a health facility visit were considered as possible sources of exposure to family planning information. Radio (32.6%) was the most commonly reported source of family planning information, followed by TV (17.5%) and newspapers (6.1%). Less than one-tenth of respondents were visited by family planning workers (9.5%) and about one-third visited a health facility during the previous 12 months (30.3%). Those who reported receiving family planning information from the three types of mass media and who had contact with a family planning worker and/or health facility were more likely to have at least eight antenatal care contacts (odds ratio for TV use=1.172, 95% CI=1.058–1.297) and deliver at a health facility (odds ratio for TV use=1.544, 95% CI=1.350–1.766). These findings indicate that family planning communication through mass media and health workers could potentially improve the utilization of antenatal and health facility delivery services in Nigeria.

Although considered a violation of human rights, female genital mutilation (FGM) is a commonly accepted practice in Nigeria in the ritual and sociocultural context of the population. In recent years, there have been strong policy actions by Nigerian legislature to curb this practice. Despite that, FGM continues to be a widespread phenomenon. In this study, we aimed to report on the prevalence of FGM, women's attitude towards this practice, and its association with selected sociodemographic factors. Methods: Nigeria Demographic and Health Surveys conducted in 2003, 2008 and 2013 provided the data for this study. The participants were married women aged between 15 and 49 years. Owing to the clustered nature of the data, a complex survey plan was created to account for cluster effects and sampling weights. Data were analysed using bivariate and multivariate regression techniques. Results: Overall prevalence of FGM was 38.9% (95% CI = 36.4–40.1), and that among their daughters was 17.4% (95% CI = 15.3–19.7). There has been a substantial increase in the prevalence of FGM in 2013 compared to its 2003 level. Respondents who had undergone circumcision were more likely to have their daughters circumcised. In all three surveys, almost all of the circumcisions were performed by traditional practitioners. In the regression analysis, respondent's age, area and region of residency, religious affiliation, educational status, and household wealth appeared to be significant predictors of FGM. Conclusion: In Nigeria, FGM remains a widely prevalent phenomenon with an increasing number of women experiencing this practice. Important regional and socioeconomic disparities were observed in the prevalence which merit urgent policy attention.

La crise économique et financière entamée en 2008 s'est accompagnée d'une inquiétude grandissante des acteurs de la santé dans les pays en développement : l'aide à la santé allait-t-elle baisser ? Cet article, basé sur une analyse des flux d'aide à la santé fournie par les membres du Comité d'aide au développement (CAD), montre que la crise économique et financière n'a pas conduit à une baisse des engagements des bailleurs. En particulier, le niveau d'engagement des pays du CAD en matière d'aide à la santé est resté globalement supérieur à celui de 2007, une année avant la crise. La répartition entre secteurs est, elle aussi, restée quasiment stable depuis 2007. Toutefois, l'article montre un essoufflement de l'aide.

The discourse surrounding the unsustainability of financing universal health care in Canada has led many stakeholders to evaluate the current system in order to consider alternative forms of funding. Several health care financing models have been suggested and include Medical Savings Accounts (MSAs), increased taxation and targeting policy to control specific cost drivers such as price inflation of physician and hospital services. This paper targets health care professionals, researchers and policy makers and calls for more awareness in evaluating public health reform initiatives for alternative measures of financing Universal Health Care. Public reform must be critically considered in order to improve the cost and delivery of health care services since private methods ultimately impede on individual and population determinants of health. Discussed here are alternative financing strategies with an evaluation of benefits, limitations, and future recommendations for Canada's health care system. ; Le discours entourant le manque de durabilité du financement des soins de santé universels au Canada a mené de nombreux intervenants à évaluer le système actuel afin d'envisager d'autres formes de financement. Plusieurs modèles de financement des soins de santé ont été avancés, notamment les comptes d'épargne-santé (CES), une hausse d'impôt et des politiques visant à contrôler les facteurs de coûts spécifiques tels que l'inflation des prix des services médicaux et hospitaliers. Cet article s'adresse aux professionnels de la santé, aux chercheurs et aux décideurs politiques, et demande que l'on se montre plus sensible quant à l'évaluation des initiatives de réforme de la santé publique relatives aux options de financement alternatives des soins de santé universels. Cette potentielle réforme publique doit être considérée afin d'améliorer le coût et la prestation des services de santé. Des méthodes privées tendent à influencer négativement, en fin de compte, sur les déterminants de la santé des individus et des po- pulations. Des stratégies alternatives de financement sont examinées dans cet article avec l'évaluation de leurs avantages et de leurs limites, et des recommandations pour le système de soins de santé du Canada.

The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.

The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the ...

The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.

Canadian provincial and territorial drug plans vary considerably in terms of eligibility criteria, and most of the insurance plans provided are subject to caps, cost sharing and exclusions. In fact, Canadians have unequal access to prescription medications, depending on their socio-economic status and place of residence. This comes at time then the effects of population aging, an increasing number of people with multiple chronic illnesses and innovations in the prescription medications field have brought about an increase in spending on these products. The question raised by this study is does a province with a better prescription drug plan have a healthier population? This study compared coverage of prescription drug plans among people 65 years old and over in three provinces: New Brunswick, Ontario and Quebec. The results of our study suggest that senior citizen health does not seem to improve. Therefore, it is impera- tive that additional research be conducted to determine the true impact of prescription drug plans on health outcomes. This would allow for the creation of tailor-made, better-targeted programs and policies to meet community needs more adequately. ; Les régimes provinciaux et territoriaux d'assurance-médicaments au Canada varient considérablement quant aux critères d'admissibilité, et la plupart des assurances offertes sont assujetties à des plafonds, à un partage des coûts, ou à des exclusions. De fait, il existe une inégalité d'accès aux médicaments sur ordonnance pour les Canadiens, selon leur statut socio-économique et leur lieu de résidence. Ceci intervient dans un contexte où les effets du vieillissement de la population, le nombre croissant de personnes atteintes de maladies chroniques multiples, et les innovations réalisées dans le secteur des médicaments d'ordonnance ont entraîné une hausse de dépenses pour ces produits. La question soulevée par cette étude est la suivante : une province avec un meilleur régime d'assurance-médicaments dispose-t-elle d'une population en meilleure santé ? Cette étude a donc comparé les protections offertes par les régimes publics d'assurance médicaments de trois provinces (le Nouveau-Brunswick, l'Ontario et le Québec) chez les 65 ans et plus. Les résultats de notre étude suggèrent que l'état de santé des aînés ne semble pas aller en s'améliorant. Il est donc impératif que des recherches additionnelles soient effectuées afin de déterminer l'impact véritable des régimes d'assurance-médicaments sur les résultats de santé. Cela permettrait de tailler des programmes sur mesure et des politiques et mieux ciblées afin de satisfaire plus adéquatement les besoins des collectivités.

Cover -- Half Title -- Series Page -- Title -- Copyright -- Dedication -- Contents -- List of figures -- List of tables -- Foreword -- List of contributors -- PART I Citizens, state, and markets -- 1 Introduction and background: global goals, local action -- PART II Frameworks for better spending -- 2 Anatomy of an effective development operation: a finance minister considers whether to borrow from the World Bank -- 3 SDG tracking through SSC for better SDG spending -- PART III South Asian landscape: moving from patronage to participation -- 4 Society for Elimination of Rural Poverty (SERP): an Indian experience of rapid poverty reduction through women's empowerment -- 5 An inspirational story: galvanizing local action for realizing global development goals: the story of BRAC making the 21st-century drive to eradicate extreme poverty at local levels -- 6 Water management is water measurement -- 7 Redefining and localizing development in Pakistan -- 8 Market-led development -- PART IV Resilient communities in fragile states: Central South Asia -- 9 Community-driven development as a mechanism for realizing global development goals: the National Solidarity Programme and Citizens' Charter Afghanistan Program -- 10 Multidimensional poverty measurement and aid efficiency: a case study from Afghanistan -- PART V Non-zero options for local development -- 11 Development aid and access to water and sanitation in sub-Saharan Africa -- 12 From more spending to better spending: the case of food and nutrition security in Ethiopia -- 13 Don't spend more, spend better: improving the social efficiency of water and sanitation services in Uruguay and South Africa -- PART VI Global South in the Global North -- 14 Indigenous peoples in Canada - the case of Global South in the Global North -- PART VII Social capital: the highest form of capital.

Humankind and the world's ecosystems face the toughest of challenges: how to feed billions more people while the climate changes, energy becomes scarcer and competition for resources intensifies. This book advocates paradigm- and policy shifts at all levels.

La première épidémie de maladie à virus Ebola en Guinée, entre 2013 et 2016, a été révélatrice des défaillances organisationnelles des institutions guinéennes dans la gestion de la crise et de la dépendance aux partenaires techniques et financiers internationaux. On a maintes fois accusé les déficits en matière de résilience pour expliquer les difficultés de gestion de la crise. Cet article a pour objectif de s'interroger sur la manière de renforcer la résilience pour améliorer la réponse aux crises sanitaires dans les États fragiles. La collecte de données de cette étude qualitative a été réalisée dans la période post-Ebola en 2017, grâce à des entretiens semi-dirigés, à une observation d'événements liés à la gestion des crises ou au relèvement post-crise, et à une analyse documentaire approfondie. Présentant les bonnes pratiques pour renforcer la gestion des crises sanitaires dans les États fragiles et un modèle tridimensionnel d'analyse de la gestion résiliente des crises sanitaires dans les États fragiles, cette étude permet de noter que la gestion des épidémies repose sur un état initial et un contexte spécifique, mais également sur les dimensions intra-organisationnelle et inter-organisationnelle puisque plusieurs organisations doivent collaborer. La dernière dimension du modèle d'analyse permet d'apprécier la résilience sanitaire selon les 5 caractéristiques de Kruk et al. (2015), soit la conscience, la diversité, l'autorégulation, l'intégration et l'adaptabilité.

The COVID-19 pandemic has ushered in a new climate of uncertainty which is fuelling protectionism and playing into nationalist narratives. Globalisation is under significant threat as governments scramble to reduce their vulnerability to the virus by limiting global trade and flows of people. With the imposition of border closures and strict migration measures, there have been major disruptions in Africa's global supply chains with adverse impacts on employment and poverty. The African economies overly reliant on single export-orientated industries, such as oil and gas, are expected to be severely hit. This situation is further aggravated by tumbling oil prices and a lowered global demand for African non-oil products. The agricultural sector, which should buffer these shocks, is also being affected by the enforcement of lockdowns which threaten people's livelihoods and food security. Lockdowns may not be the answer in Africa and the issue of public health pandemic response will need to be addressed by enacting context-specific policies which should be implemented in a humane way. In addressing the socioeconomic impact of COVID-19 on African nations, we argue that governments should prioritize social protection programmes to provide people with resources to maintain economic productivity while limiting job losses. International funders are committing assistance to Africa for this purpose, but generally as loans (adding to debt burdens) rather than as grants. G20 agreement so suspend debt payments for a year will help, but is insufficient to fiscal need. Maintaining cross-border trade and cooperation to continue generating public revenues is desirable. New strategies for diversifying African economies and limiting their dependence on external funding by promoting trade with a more regionalised (continental) focus as promoted by the African Continental Free Trade Agreement, while not without limitations, should be explored. While it is premature to judge the final economic and death toll of COVID-19, African ...

AbstractGlobally, diarrhoea is the third leading cause of death for under five-children. Women's empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women's empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57–0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65–0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women's age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women's empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women's empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women's education and decision-making power and enhancing awareness of women's human and democratic rights.