This qualitative case study identified the political enablers of the successful adoption of an important law to support breastfeeding in Kenya. The strict Breast Milk Substitute (BMS) Act adopted in 2012 has since facilitated and protected remarkable improvements in breastfeeding rates. BMS legislation was first politically debated in Kenya in the 1980s following mobilization of women-led civil society organizations, namely the Breastfeeding Information Group and the Maendeleo ya Wanawake Organization. The issue re-emerged on the political agenda in the 2000s but faced opposition from the transnational formula milk industry. Kenya’s BMS Act was ultimately adopted during a policy window opened by a constitutional reform. The Kenyan case illustrates how women’s political leadership can counteract the power of the transnational formula milk industry and help achieve strict BMS legislation. Effective female leadership for BMS legislation can occur in various political offices and positions, including those of ministers, legislators and bureaucrats. Female leaders can leverage their own influence by strategically exploiting policy windows and recruiting male allies.
Governance and participation in health
This article is a part of Open Global Right's Litigating the Climate Emergency series on how human rights and strategic litigation might best be leveraged in the climate action movements. Communities in Africa are increasingly using litigation to challenge large extractive projects that exacerbate the climate emergency and loss of biodiversity. Climate-related litigation is a growing focus within the Africa context. Several communities and legal environmental organisations have gone to court to stop harmful projects or to assert the rights of communities where there have been violations of justice. While these communities are living in very uncertain times, the cases brought before the courts show that they are not passive bystanders, using strategic climate litigation as one avenue to challenge corporations and governments. While it is time- and money-consuming, the author argues that each victory creates a ripple effect in communities in Africa and in the boardrooms of multi-national companies.
An increasing body of evidence indicates that young individuals need accurate and easily accessible gender and sexual and reproductive health (SRH) information to equip them to make well-informed choices about their SRH. The authors developed an engaging and educative seven-session radio show, which featured skits and guest speakers. A local radio station in Kenya broadcasted the show as a weekly episode over seven consecutive weeks. The authors conducted in-depth interviews with a purposeful sample of 17 parents and 20 adolescents aged 12—14 years living in an informal settlement in Nairobi and who had participated in at least three of the sessions; the radio manager and program presenter. Both parents and adolescents indicated that they felt more connected to each other after listening to the program and this enhanced communication, especially on SRH issues. Both adolescents and parents expressed greater awareness of gender and adolescent SRH issues, which were rarely discussed in detail in open forums in their context prior to the radio program. They recommended that such radio programs run regularly as they provide a platform where sensitive issues about adolescent health can be shared and discussed openly, allowing for both adolescent and community participation. Radio programming was perceived as a good platform for knowledge transfer and discussions about gender norms and SRH among young adolescents, if messages are designed to resonate with a diverse audience.
The 156th Session of the WHO Executive Board, held in Geneva, witnessed intense deliberations over the financial repercussions of the United States' withdrawal from the organization. Member States engaged in complex negotiations that revealed deep divisions about how to respond to the significant budget shortfall, with proposals ranging from reducing the base budget from USD 5.3 billion to USD 4.9 billion to potentially increasing assessed contributions by 20%. High income countries largely advocated for postponing new resolutions and prioritizing activities, while low income countries strongly resisted such approaches, arguing for the preservation of the organization's comprehensive mandate. The discussions highlighted the underlying vulnerabilities of the WHO's funding model, which heavily relies on voluntary earmarked contributions, and underscored the challenges of maintaining critical global health functions amid financial uncertainty. Diplomatic exchanges were marked by nuanced debates about prioritization, with countries like Russia, China, and India questioning the sudden financial adjustments and calling for more measured, transparent approaches to budgeting and resource allocation. The session ultimately reflected the complex task of balancing organizational sustainability with the diverse health priorities of Member States in an evolving global health landscape.
This systematic review and meta-analysis investigated self-medication prevalence in Uganda through 22 eligible studies encompassing 9,113 participants across different demographics and regions. Analysis revealed that at least one in two Ugandans self-medicate, with antibiotics being the most commonly self-medicated drugs. Key contributing factors included ease of access to medications, perceived cost effectiveness, long hospital waiting times, home storage of drugs, and perceptions of minor illnesses. The high prevalence of antibiotic self-medication is particularly concerning in the context of antimicrobial resistance, indicating an urgent need for awareness campaigns about the dangers of self-medication.
This paper evaluated the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application in addition to standard HIV pre-exposure prophylaxis, and 313 from Tanga who received pre-exposure prophylaxis alone. Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, the authors conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% of participants in the intervention arm and 20.1% in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm. Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.
Dr. Kangaude, a prominent figure in Malawi's reproductive health landscape, shares insights on the strategies Civil Society Organisations (CSOs) are employing to advance reproductive justice in Malawi. He emphasizes the critical role of advocacy in raising awareness, influencing policy, and challenging discriminatory laws. Collaboration between African countries, he argues, is essential to share experiences, strengthen regional networks, and amplify collective voices. Dr. Kangaude also discusses the numerous challenges CSOs face and the Nyale Institute's implementation of innovative strategies to overcome these obstacles. The episode also highlights the success stories and impactful cases championed by Nyale Institute, demonstrating the power of strategic interventions and unwavering commitment to reproductive justice in Africa.
Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children. A descriptive qualitative evaluation was conducted in 2020 across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. There were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the programme. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of and how to take the anti-retroviral treatment. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, health care workers felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. This study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased anti-retroviral treatment literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation.
The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination. Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research. GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that GHI earmarking and conditions drive funding allocations regardless of countries’ priorities. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers with both positive and negative implications. To maximise returns on GHI support, the authors suggest that there is need to ensure that their approaches are comprehensive as opposed to being selective; to improve GHI country level governance and alignment with countries’ changing epidemiologic profiles; and to strengthen their involvement of civil society.
How can women in vulnerable circumstances move beyond hopelessness, extreme poverty, and the health and livelihood challenges of a global pandemic? What are the best research approaches to make their experiences count in post-pandemic recovery efforts and future preparedness? Ask them. Two research projects in the provinces of Eastern Cape and KwaZulu-Natal, South Africa, are using experiential methodologies to reveal women’s stories, ideas and solutions to their post-pandemic recovery. By taking two different approaches — one ethnographic and the other a workshop series combined with trial cash transfers —, these two projects aimed to understand the multidimensionality of the lives and circumstances of economically disadvantaged women and investigated different ways to amplify their voices using inclusive approaches. Common themes have emerged from the oral histories collected to date. Researchers report that the pandemic disproportionately affected women, many of whom lost their jobs. Workplaces, health centres and other services closed, leaving women disconnected from their social networks. Adult children and spouses moved home, causing even greater strain and leading to increases in domestic violence. Greater numbers of youth pregnancies added to women’s already difficult care burden. Many women reported that debt closed in. High inflation further compounded the problem, leaving women’s households in a continuous cycle of economic deficit. They continue to struggle with food insecurity and an almost universal dependence on social grants for survival. Women reported a new normal: living with stress, mental illness, isolation and substance use.