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AbstractOver the last few months extremely positive accounts have been circulating of Cuba's role and approach in the COVID‐19 response, both nationally and internationally. A universal healthcare system with family doctors and nurses providing door‐to‐door services, as well as the swift introduction of measures to control movement have been some of the factors underlying this relative success. However, this success hides the disadvantageous social reality facing the majority of Cubans, including differential access to services, a health system that is struggling and limited choice and freedoms.

In 1993 a study looking at the impacts of HIV and AIDS on livelihoods was conducted in two districts in Zambia—Mpongwe and Teta. Twelve years later in 2005 a restudy of the same areas was undertaken. The aim was to understand what had happened to individuals and clusters in the intervening period in terms of their adaptability and resilience to HIV and AIDS, and to assess whether the "cluster," or livelihood network methodology was an effective approach to explore the impact of AIDS on farming, livelihoods, and social change. Significant changes had occurred at meso and national levels; Mpongwe had become a district capital, agricultural subsidies had been removed, health services had been decentralized and ART was becoming more available. As predicted by the first study, in 2005 Mpongwe was experiencing the full‐blown impact of AIDS. However, the most significant finding of the study, which the livelihoods network methodology helped to highlight, was how social units had adapted and how livelihoods had remained surprisingly resilient. In Teta, AIDS impacts had been much less and a shift back to more traditional farming systems was seen. Because the future holds an inevitable increase in shocks and stresses, with now climate change too, the study highlights the need for more creative and informed approaches for buttressing the social protection functions of livelihood networks.

Can cash transfer programmes have "transformative" effects? / Maxine Molyneux, with Nicola Jones & Fiona Samuels --- "Being able to breath again" : the effects of cash transfer programmes on psychosocial wellbeing / Fiona Samuels & Maria Stavropoulou -- Can social protection affect psychosocial wellbeing and why does this matter? : lessons from cash transfers in Sub-Saharan Africa / Ramlatu Attah [and 5 others] -- Accessing the "right" kinds of material and symbolic capital : the role of cash transfers in reducing adolescent school absence and risky behaviour in South Africa / Michelle Adato, Stephen Devereux & Rachel Sabates-Wheeler -- Effects of cash transfers on community interactions : emerging evidence / Sara Pavanello, Carol Watson, W. Onyango-Ouma & Paul Bukuluki -- From social accountability to a new social contract? : the role of NGOs in protecting and empowering PLHIV in Uganda / Badru Bukenya -- Programming for citizenship : the conditional cash transfer programme in El Salvador / Michell e Adato, Oscar Morales Barahona & Terence Roopnaraine -- Pathways to citizen accountability : Brazil's Bolsa Família / Natasha Borges Sugiyama -- Transforming cash transfers : citizens' perspectives on the politics of programme implementation / Nicola Jones, Bassam Abu-Hamad, Paola Pereznieto & Kerry Sylvester -- Understanding social accountability : politics, power and building new social contracts / Sam Hickey & Sophie KIng.

Cuba remains one of the few countries still governed by a communist party. Despite its socialist commitments, including to gender equality, these have not been fully achieved and norms concerning gender roles are often at variance with revolutionary values. Focusing on youth and particularly young women, this article draws on primary data collected in Cuba in 2018–19 to explore young people's sexual and reproductive health decisions. The analysis highlights how despite the family planning services and educational opportunities made available to them, young women's reproductive and sexual choices are often determined by men and by values that accord primacy to marriage and motherhood, as conservative values are increasingly gaining a foothold.

AbstractThe introduction of technology, particularly mobile phones, in the mediation of commercial sex work (CSW) has meant that sex work is expanding from traditional venue based (such as through hotels and massage parlors) work to freelance sex work. It has also changed the face-to-face negotiation in commercial sex work to negotiations mediated online or by phone. Apart from a few programmes, interventions largely use establishments as entry points for their programming and are therefore excluding many girls and women who engage in CSW through personal contacts or facilitated by social media. This article is based on a two-year qualitative study in four districts of Nepal, in Delhi (India), and the Indo-Nepal border in eastern Nepal. It gives a short overview of the girls and their life in the adult entertainment sector (AES), which is the main entry point for CSW, and discusses how technology is increasingly used to mediate CSW. Based on our findings, which show that technology is displacing establishment-based CSW in Nepal, we argue that to ensure that we do not leave girls behind, programmes and interventions targeting venues where girls engage in CSW should re-consider their strategies for reaching girls working in the AES.

There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. To do this, the article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. At the macro level, governance with effective and committed leaders was found to be vital for achieving positive health outcomes. This was underpinned by clear commitment from donors coupled by a significant increase in funding to the health sector. At the meso level, where policies are operationalized, inter-sectoral partnerships as well as decentralization and task-shifting emerged as critical. At micro (service interface) level, community-centred models and accessible and appropriately trained and incentivized local health providers play a central role in all study countries. The key drivers of progress are multiple, interrelated and transversal in terms of their operation; they are also in a constant state of flux as health systems and contexts develop. Without seeking to offer a blueprint, the study demonstrates that a 'whole-system' approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems.