WHO guideline for brief sexuality-related communication: implications for STI/HIV policy and practice.

Brief sexuality-related communication (BSC) aims to identify current and potential sexual concerns and motivate those at risk to change their sexual behaviour or maintain safe sexual behaviour. BSC in primary health care can range from 5 to 60 minutes and takes into account biological, psychological and social dimensions of sexual health and wellbeing. It focuses on opportunistic rather than systematic or continuous communication and can be used in conjunction with already established prevention programs. The informational and motivational techniques of BSC enable health care providers to communicate more effectively with their patients, encouraging them to take steps to avoid HIV and sexually transmitted infections. The WHO Department of Reproductive Health and Research, following a review and assessment of existing evidence with regards to BSC, has recently published the guideline on Brief Sexuality-Related Communication: Recommendations for a Public Health Approach.

Complexity versus the technical fix or how to put sexuality back into sexual health.

These reflections consider the failure of the public health establishment to invest in evaluations of interventions that support community groups to shift individual and community behaviours in favour of sexual well-being, sexual rights and sexual satisfaction. This article queries the willingness to invest substantially in researching technical interventions without simultaneously assessing their potential unintended consequences for sexual health well-being; the associated lack of will to invest in social research is also queried. The paper proposes that part of the challenge is the research paradigm that fears complexity, despite growing recognition that sexuality and sexual health are products of a complex intersection of factors, and they require research and evaluation methodologies that recognise such complexity. The paper argues that given the wide-ranging efforts to promote shifts in community norms and practices in relation to sexuality, an opportunity is being lost due to the failure to use ongoing process and outcome evaluations to inform interventions that would provide implementers and groups in communities with resources and ideas to strengthen the quality of their efforts in different contexts, thereby failing to meet the promise of the International Conference on Population and Development.

Considering strategic litigation as an advocacy tool: a case study of the defence of reproductive rights in Colombia.

Women's Link Worldwide developed a test to determine when an environment is conducive to social change through strategic litigation. We first present our understanding of strategic litigation, and then discuss four conditions for successful and sustainable change using strategic litigation: (1) an existing rights framework; (2) an independent and knowledgeable judiciary; (3) civil society organizations with the capacity to frame social problems as rights violations and to litigate; and (4) a network able to support and leverage the opportunities presented by litigation. Next, we present examples from our work in Colombia that show how analysis of these conditions informed our litigation strategy when confronting a powerful public official who opposes reproductive rights. Two litigation strategies were adopted. The first case was not successful in the courts, but allowed us to introduce our message and build support amongst civil society. The second case built on this momentum and resulted in a victory. Strategic litigation is a powerful tool to advance rights as well as hold governments accountable and ensure compliance with human rights obligations. The strategies developed can be adapted for use in other contexts. We hope they inspire others to protect and promote reproductive rights through strategic litigation when women cannot fully enjoy their rights.

Effective social justice advocacy: a theory-of-change framework for assessing progress.

This article offers a theory-of-change framework for social justice advocacy. It describes broad outcome categories against which activists, donors and evaluators can assess progress (or lack thereof) in an ongoing manner: changes in organisational capacity, base of support, alliances, data and analysis from a social justice perspective, problem definition and potential policy options, visibility, public norms, and population level impacts. Using these for evaluation enables activists and donors to learn from and rethink their strategies as the political context and/or actors change over time. The paper presents a case study comparing factors that facilitated reproductive rights policy wins during the transition from apartheid to democracy in South Africa and factors that undermined their implementation in the post-apartheid period. It argues that after legal and policy victories had been won, failure to maintain strong organizations and continually rethink strategies contributed to the loss of government focus on and resources for implementation of new policies. By implication, evaluating effectiveness only by an actual policy change does not allow for ongoing learning to ensure appropriate strategies. It also fails to recognise that a policy win can be overturned and needs vigilant monitoring and advocacy for implementation. This means that funding and organising advocacy should seldom be undertaken as a short-term proposition. It also suggests that the building and maintenance of organisational and leadership capacity is as important as any other of the outcome categories in enabling success.

Преобразование систем здравоохранения: гендер и права в охране репродуктивного здоровья: учебная программа для менеджеров здравоохранения

Данное руководство является результатом 6 лет испытаний и адаптации в тесном сотрудничестве с учреждениями в различных регионах мира и предоставляет уникальную учебную программу развития аналитических средств и навыков, необходимых для интеграции гендерной проблематики и прав человека в разработку программ и политики в области сексуального и репродуктивного здоровья. Трехнедельный курс предназначен для руководителей программ в области здравоохранения, специалистов по планированию, политиков и других ответственных лиц в области сексуального и репродуктивного здоровья.

Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services.

This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health (SRH) services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to programme management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes. Setting up of community health structures, decentralization and community financing are three important strategies used for promoting participation and accountability within reforms. The scant evidence on the impact of these strategies suggests that marginalized groups and sexual and reproductive rights based groups are poorly represented in the forums for participation, and that hierarchies of power between and amongst health personnel and the public play out in these forums. Community financing has not lead to enhanced service accountability. As a result of the above limitations, community participation in health sector reforms has rarely strengthened accountability with respect to provision of comprehensive SRH services. In this context, rights (including sexual and reproductive) based groups and researchers need to engage with design, monitoring and evaluation of health sector reforms, both from inside as participants and outside as pressure groups. Participation contracts enhancing powers of civil society representatives, quotas for participation (for women, other marginalized groups and rights-based organizations), and investment in capacity building of these stakeholders on leadership and sexual reproductive rights and health are pre-requisites if participation is to lead to health and SRH service accountability. Community participation and service accountability hence requires more and not less investment of resources by the state.

Organising and financing for sexual and reproductive health and rights: the perspective of an NGO activist turned donor.

This paper is a reflection on some of the successess and challenges that followed in the aftermath of the International Conference on Population and Development (ICPD) Cairo, 1994, and the capacity of civil society and of donors to address them. It is written with two voices--from my experience as an NGO activist for sexual and reproductive rights since the early 1980s and my experience as a programme officer for a donor for the last 18 months. It calls for a focus on implementation of services within public health and education systems, the need to deepen the capacities of activists and build new leaders, and the value of alliances with other movements whose goals are also being challenged by macro-economic forces and fundamentalist movements. At national level, I suggest three major goals: monitoring public sector spending, strengthening public health system capacity for implementation, and advocacy and community organisation to enable shifts in public understanding of sexual and reproductive rights. Lastly, as regards funding, it calls for dialogue about funding issues between NGOs and donors, for donors to increase national capacity development in the global south and for all those committed to change in relation to sexual and reproductive health and rights to commit themselves for the long haul, given the slow pace of change.

The human face of decentralisation and integration of health services: experience from South Africa.

This paper explores the processes of policy-making, budgeting and service implementation in three provinces of South Africa, drawing on interviews with health managers at different levels of government. It illustrates how the process of decentralisation creates disjunctures between the policy-making authority of higher levels of government and the implementation capacity of service provision levels. It also explores the complex dynamics between those responsible for specific policies, such as reproductive health policies, and those responsible for managing the integrated delivery of all policies, with their resultant contestations over authority and resources. The pace of change in South Africa and the enormous capacity it requires, both in relation to financial management and the technical skills needed for specific programmes, has created a sense of frustration and demoralisation. Whilst shortage of financial resources, particularly as reflected in shortage of staff, is frequently assumed to be the biggest constraint in this context, most managers identified other issues, particularly staff morale, as greater barriers to the delivery of high quality health services. The paper concludes that it is the complexity of experience and feelings described by health managers that may determine the extent and quality of service delivery. For this reason, both practice and research need to give greater attention to issues of power relations and personal experience of change.