The HIV/AIDS pandemic in Kenya: an investigation into the perceptions of Kenyans toward people living with HIV/AIDS and government programmes

The HIV/AIDS pandemic is compounded by the continued stigmatization of the virus/disease and of people living with HIV/AIDS (PLWHA). Employing structuration theory, this study sought to examine the perceptions of Kenyans toward their government's efforts to curtail HIV/AIDS as well as their attitudes toward PLWHA. Data for this study were collected using an open-ended online survey. In total, 103 participants (25.3%) completed the survey. We used snowball sampling to select prospective participants known to the researcher; they were sent a link to the survey via email or direct message on a social networking site like Facebook or WhatsApp, and were asked to share the survey with people in their social circles. Data were analysed using thematic analysis. Findings revealed that some participants had confidence in the Kenyan government's efforts to address the HIV/AIDS pandemic, while others showed no confidence in government-led initiatives. Consistent with previous research, this study found that stigma towards HIV/ AIDS and PLWHA still exists. Practical and theoretical implications of the findings are discussed

Operationalizing Universal Health Coverage in Nigeria through Social Health Insurance

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper; we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC; it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme

Development of emergency medicine in Rwanda

"Rwanda; known as the ""Land of a Thousand Hills;"" is a small; East African country that was the site of the devastating 1994 genocide. In the past 18years; this post-conflict country has made tremendous progress in rebuilding itself and its health infrastructure. The country has recovered or surpassed many of its pre-1994 health levels; including reduction in HIV/AIDS prevalence; under-five mortality and road traffic accidents. Nevertheless; Rwanda continues to face a high burden of disease. The leading causes of mortality in Rwanda include complications of HIV/AIDS and related opportunistic infections; severe malaria; pulmonary infections; and trauma; and are best managed with emergency and acute care services. However; health care personal resources remain significantly lacking; and there is currently no emergency medicine-trained workforce. The Rwandan government; partnering with international organizations; has launched a campaign to improve human resources for health; and as a part of that effort the creation of training programs in emergency medicine is now underway. The Rwandan Human Resources for Health program can serve as a guide to the development of similar programs within other African countries. The emergency medicine component of this program includes two tracks: a 2-year postgraduate diploma course; followed by a 3-year Masters of Medicine in Emergency Medicine. The program is slated to graduate its first cohort of trained Emergency Physicians in 2017."

Expanding vulnerability; dwindling resources:implications for orphaned futures in Uganda

"The recent government and donor response to the ""orphan crisis"" in Africa has expanded beyond orphans to incorporate children in a number of difficult circumstances by employing the concept of OVC; orphans and The recent government and donor response to the ""orphan crisis"" in Africa has expanded beyond orphans to incorporate children in a number of difficult circumstances by employing the concept of OVC; orphans and vulnerable children."" While the general concept of vulnerability helps acknowledge the needs of children beyond orphanhood; its expanding definition under policy development in Uganda has inflated the numbers of children that fall under its purview to about half the child population. This expanded definition of OVC also creates a hierarchy of vulnerability that affects which OVC will receive assistance in the midst of ever-dwindling aid resources.This paper explores the dynamics of childhood vulnerability in the Ugandan context from policy to practice. While Ugandans' growing acknowledgement of child vulnerability is in itself seen as an achievement by policymakers; it creates an untenable demand for OVC services and potentially reifies vulnerability as an ironically privileged and empowered identity. ."

Assessing Interventions Available to Internally Displaced Persons in Abia State; Nigeria

Internally displaced persons are faced with several problems; such as sexual violence; and deserve appropriate intervention; especially in view of the increasing prevalence of HIV/AIDS and other infections in Nigeria. This study attempts to assess interventions offered by governmental authorities and organizations to internally displaced persons and to identify gaps in services as well as to identify what needs to be strengthened. Method: The author reviewed relevant published and unpublished documents and collected data by interviews with semi-structured questions. Twenty-five organizations and government and police departments and 55 internally displaced persons were interviewed.Results: None of the organizations; including governmental institutions; provided social services or assistance in prevention of HIV/AIDS to internally displaced persons. The main services provided by 17 (68) organizations to 43 (78.2) of internally displaced persons were provision of food; clothing and money; but these were provided on an ad hoc basis. Only 3 organizations (12) included spiritual counseling and resolution of communal conflicts in their services. Conclusion: The fact that most organizations; including the government; do not have services for internally displaced persons indicates lack of support for internally displaced persons. The government should be urged to include these people in most prevention services; including HIV/AIDS prevention and treatment. This should help reduce the national prevalence of HIV/AIDS

The Challenges of Managing Government-Seconded Health Workers in Private not-for-Profit Health Facilities of Kibaale District; Uganda

Private health care providers are an important component of pluralistic national health systems. In Uganda; the public-private partnership for health (PPPH) has led to the government assisting the private health sector in various ways; in recognition of and support to their work. Apart from financial assistance; the government deploys civil servants to work in private-not-for-profit (PNFP) health facilities. Such government-seconded health workers are recruited; deployed and paid by the government but they work under the management of the PNFP health units. In the rural and remote district of Kibaale in mid-western Uganda; government-seconded health workers form 48of the key professional staff in PNFP health services. However; government secondment raises a number of important managerial and human resource challenges. PNFP health care managers have some workers over whom they do not have full authority and control. The seconded workers have to serve two authorities and satisfy them equally. This cross-sectional descriptive study aimed at identifying the problems arising from this kind of relationship in a district where PNFP health units are heavily dependent on government-seconded personnel; and how such problems may be addressed. It was found that there is unequal treatment of seconded and non-seconded staff; with the former receiving better pay; and having more professional management than the latter. However; they felt there was too much workload in PNFP units compared to government and were not comfortable with the PNFP prohibition of private practice. In addition; they felt that they were not trusted by the PNFP managers and that they had limited or no opportunities for career development and further studies. PNFP managers felt they had no control over seconded staff and felt that they have no possibility to participate in the selection of staff to be seconded to their units. As a result; seconded staff were perceived to have no commitment to work in PNFP units; and to be prone to absenteeism; illegal private practice; demand for big financial allowances; abrupt attrition and pilferage of health care supplies. This paper proposes quick enactment of the PPPH policy to define the relationship between the public and the private sectors. It also proposes that the government gives unconditional funding to the PNFP facilities on a contractual basis; and only demands for accountability on agreed outputs. This would facilitate the PNFP managers to recruit their own staff and endeavour to attain the agreed outputs

An Assessment of Government Policy Response to HIV/AIDS in Ghana

The HIV/AIDS epidemic in Africa has assumed a dimension raising heartbreaking anxiety among national governments and civil society groups. In Ghana for example; the pandemic is well-documented and has gone beyond a health problem; and now encompasses all socio-economic aspects of life.The estimated rate of infection from the mid-1980s to 2000 has more than doubled; and in spite of the control efforts by various groups and organisations; prevalence of the disease has not declined notably.This paper assesses government policy; programmes and strategies to combat the disease; using analysis of time trend sentinel data and weighting these against control efforts.The assessment revealed that 380 000 adults and 36 000 children are currently infected. There are wide spatial variations in prevalence across the country and the overall national prevalence has fluctuated over time; standing at 2.6 in 2000; 3.6 in 2002 and 3.1 in 2004.This appears relatively lower than in adjacent countries; where prevalence is around 5 and over 25 in East and Southern African countries. Although the review found a robust multipronged government intervention approach to containing the disease; we are hesitant to claim that the fairly stable or low national prevalence in Ghana compared with its immediate neighbours may have been the consequence of the effectiveness of national AIDS control programmes and impact of government interventions

Increasing Equity among Community-Based Health Insurance Members in Rwanda

The community-based health insurance (CBHI) scheme launched by the Government of Rwanda (GoR); reached 91% of the population in 2010; starting from 7% in 2003. Initially; all CBHI members paid the same fees; regardless of their personal income; and the poorest citizens faced challenges in paying premiums (almost US$ 1.50 per person). A mechanism was thus urgently needed to guarantee access to health care for the most vulnerable and promote equity among members. The GoR decided to introduce a stratification system based on the socioeconomic status of the population; referred to as Ubudehe. Together with partners; including the Integrated Health Systems Strengthening Project (IHSSP); the GoR developed a national database that stratifies Rwandan citizens by income. To date; more than 10 million residents' records; representing 96% of Rwanda's population; have been entered into the database. This database helped identify the most vulnerable based on socioeconomic status (about 25% of the population). Identification of the poorest among the population has allowed an increase in CBHI funds due to identification of individuals who have a greater capacity to pay. The database thus improved the financial viability and management capacity of the CBHI scheme

Waiving taxes on bed net is a wise and strategic move by Government. It should be applauded

The Government of Uganda has to be congratulated for waiving taxes on bednets and related materials; as a step in ousting malaria from Uganda. Malaria is well recognised as the leading cause of ill-health among our people. It accounts for many deaths especially children aged less than five years. malaria is not a new disease and people are aware of the efforts in the 60s; aimed at controlling it. those efforts failed mainly because they were not sustainable. The current administrators and health planners are; therefore; facing a challenge of designing malaria control programmes which are cheap; effective and sustainable