Community Non-governmental Organizations Research Articles

A model of community youth mental health support services in the global South: A description and use of school-based services delivered by a non-governmental organisation in South Africa

ObjectiveYoung people in low- and middle-income countries (LMICs), including South Africa, are disproportionately affected by multiple risk factors for developing mental health problems and there are numerous barriers to accessing mental health care. In such contexts non-governmental organisations (NGOs) play a key role in providing support. We report on the mental health care services provided by NGO Community Keepers in South Africa. MethodCommunity Keepers (CK) offers psychosocial support to young people, parents, and teachers, during regular school hours, and free of charge. At the end of 2019, CK was based at 23 schools in 12 areas in the Western Cape Province, South Africa. In this paper we describe the model of service provision and present descriptive statistics from retrospective observational service data using routinely collected quantitative data from 2019, including details about referrals received, referral sources and reasons, and feedback received from children, parents, and teachers on the psychosocial support CK delivered. ResultsDuring 2019, 34 676 individuals accessed 18169 psychosocial support sessions rendered by CK. The most common referral source of learners to CK was self-referrals (40.6%), and the main referral reasons were emotional (psychological) problems, behaviour problems, or family (community) problems. At termination of therapy 320 (79.2%) learners said they strongly agreed that they would recommend CK to someone at their school. At termination of therapy with learners, 95 (39.3%) teachers rated CK’s services as excellent, 139 (57.4%) teachers gave a rating of good, and 204 (79.7%) parents reported an improvement in their relationship with their children. ConclusionsCK is an example of how psychosocial support can be embedded in schools in a LMIC. CK’s multifaceted model of service delivery could be used by other school-based mental health care service providers in other LMICs to inform and/or refine the services that they wish to offer.

Knowledge and Perception towards Uterine Fibroids among Ante-Natal Clinic Attendees in Two Sub-Urban Communities in Delta State, Nigeria

Uterine fibroid is a common cause of recurrent bleeding and pain in women of reproductive age and it can have a severe impact on a woman's quality of life. The aim of this study was to assess the knowledge and perception of women in suburban communities toward uterine fibroid. It was a cross-sectional descriptive study, using an interviewer-administered questionnaire to assess the knowledge and perception of ante-natal clinic attendees towards uterine fibroid in Delta State. A total of four hundred ante-natal clinic attendees were selected using a multistage sampling technique. Data analysis was done using Statistical Package for Social Sciences Version 23 with statistical significance set at p<0.05. Results obtained indicate that the mean age of respondents was 31.0 (± 8.5) years. Overall, 16% of respondents had good knowledge of uterine fibroid. About, 73% of study participants had a positive perception of uterine fibroid. There was no statistically significant association (p>0.05) between the socio- demographic variables with knowledge and perception towards uterine fibroid among our study respondents. Majority of respondents, 99.0% were aware of uterine fibroid, however, overall knowledge of uterine fibroid was poor. Study respondents had a positive perception towards uterine fibroid. Although study respondents had a positive perception towards uterine fibroid, there were many misconceptions concerning uterine fibroid among these respondents. There is a need for health professionals to disseminate accurate information about fibroids. Also educational programs should be carried out in sub-urban areas in order to increase their knowledge and perception of uterine fibroid. These programs can be sponsored by the community non-governmental organizations and the Government.

We Need to Find Right Balance Between Telehealth, In-Person Care

We Need to Find Right Balance Between Telehealth, In-Person Care

NGO Capacity Building in the Wake of Japan’s Triple Disaster of 2011: The Case of the TOMODACHI NGO Leadership Programme (TNLP)

ABSTRACT Starting with the assessment of the humanitarian response to Japan’s “3/11” triple disaster of 2011 (earthquake, tsunami and Fukushima nuclear disaster) provided by civil society actors, this article explores the problem of the capacities and capacity building of Japanese non-governmental organisations (NGOs) working in relief and recovery sectors and beyond. The article uses a case study of the TOMODACHI NGO Leadership Programme (TNLP) (2013–2016) to critically assess ongoing capacity-building challenges facing the Japanese NGO community. The article proposes that 3/11 was a significant critical juncture that spurred further efforts to improve NGOs’ institutional capabilities and preparedness. It further contends that the TNLP contributed to delivering humanitarian principles, safety and security, and advocacy-related training opportunities for members of the Japanese NGO community. The capacity needs of Japanese NGOs and measures to address these, as illuminated by the post-3/11 initiatives and the TNLP presented in this article, also demonstrate the limited commitment of the Japanese government to support the growth of NGOs. Finally, the utility of joint projects by Japanese and Western NGOs for both delivering capacity development and advancing mutual understanding is discussed on the basis of relevant TNLP activities.

Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher

Realist evaluation, a methodology for exploring generative causation within complex health interventions to understand ‘how, why and for whom’ programmes work, is experiencing a surge of interest. Trends indicate that...

Linking intravenous drug users to treatment through non-governmental organizations in Ukraine: how well is it working?

Alliance for Public Health, the International Charitable Foundation, coordinates HIV prevention in Non-Governmental Organizations (NGO) working with people who inject drugs (PWID) in Ukraine. We aimed to describe the performance of the differential model of linking PWID to HIV care and treatment (Community Initiated Treatment Intervention - CITI). A retrospective cohort study using routine program data was conducted among 8,927 PWID who were tested positive for the first time during January 2016 - June 2017. Study outcomes were enrollment into CITI and initiating antiretroviral treatment (ART). Factors associated with outcomes were estimated by logistic regressions with random effects. Among the study participants, 54% enrolled into CITI and 23% initiated ART. CITI enrolment was associated with being married (adjusted odds ratio (AOR) = 1.17; 95%: 1.02-1.34); less than weekly compared to daily (AOR = 1.31; 95%: 1.13-1.52); less than 5 years of drug use compared to > 14 years (AOR = 1.73; 95%: 1.40-2.13), and having no criminal records (AOR = 1.30; 95%: 1.12-1.50). Factors of non-ART initiation were male gender (AOR = 1.33; 95%: 1.16-1.53); being single (AOR = 1.48; 95%: 1.21-1.82); drug use duration > 14 years compared to < 5 years (AOR = 1.38; 95%: 1.03-1.85), unemployment (AOR = 1.45; 95%: 1.15-1.83) and history of incarceration (AOR = 1.21; 95%: 1.003-1.45). Mobilizing the NGO community and PWID to engage in outreach HIV testing activity and harm reduction for key populations has succeeded in opening the gateway to prevention, care and ART for thousands of PWID in Ukraine.

Bridging Barriers, Building Partners: Success of a Multistakeholder Collaborative Effort in Building and Implementing a Free Mammography Programme for Underprivileged Malaysian Women

Background and context: Research has revealed two large problems in the Malaysian breast cancer control context. First, a large disparity existed in diagnostic stages of Malaysian patients during first presentation; with a large percentage of patients presenting in Stage 3 or 4. Second, patients presenting in later stages of disease were revealed to be of lower socioeconomic backgrounds. Shortcomings are thus thought to exist in the capability of women from lower socioeconomic groups to access breast cancer screening. To address these gaps, the National Cancer Society of Malaysia conceptualized and put together a multistakeholder collaborative project. Aim: The aim of this project was to build, finance and implement a free mammography program for underprivileged Malaysian women. Strategy/Tactics: To ensure geographic equity in provision of this program, 14 individual private hospitals in 10 different states in peninsular Malaysia were negotiated with and agreed to provide the mammogram at highly competitive prices. To address transport and other costs which may have acted as a barrier for patients to attend their screening, transportation costs for groups going for their screening was also subsidized. Additional stakeholders' engaged were nongovernmental organizations (NGOs) especially those working with the economically underprivileged such as religious and other community NGOs. They were roped in as partners to spread the message, identify eligible participants and schedule visits. Some NGOs carried this out as part of their own outreach activities; reserving specific days at the screening centers for themselves. Program/Policy process: The program consisted of a free mammogram provided to Malaysian women above 40 years of age who were determined to be underprivileged; defined for this program as those having a monthly household income below the poverty line (RM5000). If the mammogram was found to be suspicious, a confirmatory breast ultrasound was also performed sans payment. Once conceptualized, the program was successfully pitched by NCSM to ETIQA Insurance, a large Malaysian insurer, who agreed to fund this project as part of their sustainable corporate social responsibility (CSR) initiative. In total, the program funded mammograms for 5000 women over a period of 1 year from July 2017 to July 2018. NCSM advertised the program through various channels; including traditional media, social media, and at various outreach programs and events. Outcomes/What was learned: The program has run for 8 months and has already screened 3550 women nationwide. The multistakeholder collaborative effort has been highly successful at creating awareness on breast cancer screening and providing accurate breast cancer screening for a large number of underprivileged women, some for the first time in their lives.

Securitizing HIV/AIDS: a game changer in state-societal relations in China?

BackgroundChina has experienced unprecedented economic growth since the 1980s. Despite this impressive economic development, this growth exists side by side with the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and severe acute respiratory syndrome (SARS) crises and the persisting deficiencies in public health provision in China. Acknowledging the prevailing health problems, the Chinese government has encouraged the development of health non-governmental organizations (NGOs) to respond to the health challenges and address the gaps in public health provision of the government. HIV/AIDS-focused NGOs have been perceived as the most outstanding civil society group developed in China. Considering the low priority of health policies since the economic reform, the limitation of the “third sector” activity permitted in authoritarian China, together with the political sensitivity of the HIV/AIDS problem in the country, this article aims to explain the proliferation of HIV/AIDS-focused NGOs in China with the usage of the securitization framework in the field of international relations (IR).MethodsThe research that underpins this article is based on a desk-based literature review as well as in-depth field interviews with individuals working in HIV/AIDS-focused NGOs in China. Face-to-face interviews for this research were conducted between January and May in 2011, and between December 2016 and January 2017, in China. Discourse analysis was in particular employed in the study of the security-threat framing process (securitization) of HIV/AIDS in China.ResultsThis article argues that the proliferation of HIV/AIDS-related NGOs in China is largely attributed to the normative and technical effects of HIV/AIDS securitization ushered in by the United Nations Security Council (UNSC) and supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria (hereinafter Global Fund) observed in China. Despite depicting a positive scenario, the development of HIV/AIDS-focused NGOs in China generated by the international securitization efforts is largely limited. An internal and external factor was identified to verify the argument, namely (1) the reduction of international financial commitments, as well as (2) the fragmentation of HIV/AIDS-focused NGO community in China.ConclusionsThis article shows that international securitization weakened with the rise of Chinese commitment on HIV/AIDS interventions. In other words, HIV/AIDS-related responses delivered by the national government are no longer checked by the global mechanism of HIV/AIDS; thus it is unclear whether these NGOs would remain of interest as partners for the government. The fragmentation of the HIV/AIDS community would further hinder the development, preventing from NGOs with the same interest forming alliances to call for changes in current political environment. Such restriction on the concerted efforts of HIV/AIDS-related NGOs in China would make achievement of the Sustainable Development Goals (SDGs) to foster stronger partnerships between the government and civil society difficult, which in turn hindering the realization of ending HIV/AIDS in the world by 2030.

Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era

BackgroundStronger health systems, with an emphasis on community-based primary health care, are required to help accelerate the pace of ending preventable maternal and child deaths as well as contribute to the achievement of the Sustainable Development Goals (SDGs). The success of the SDGs will require unprecedented coordination across sectors, including partnerships between public, private, and non-governmental organizations (NGOs). To date, little attention has been paid to the distinct ways in which NGOs (both international and local) can partner with existing national government health systems to institutionalize community health strategies.DiscussionIn this paper, we propose a new conceptual framework that depicts three primary pathways through which NGOs can contribute to the institutionalization of community-focused maternal, newborn, and child health (MNCH) strategies to strengthen health systems at the district, national or global level. To illustrate the practical application of these three pathways, we present six illustrative cases from multiple NGOs and discuss the primary drivers of institutional change. In the first pathway, “learning for leverage,” NGOs demonstrate the effectiveness of new innovations that can stimulate changes in the health system through adaptation of research into policy and practice. In the second pathway, “thought leadership,” NGOs disseminate lessons learned to public and private partners through training, information sharing and collaborative learning. In the third pathway, “joint venturing,” NGOs work in partnership with the government health system to demonstrate the efficacy of a project and use their collective voice to help guide decision-makers. In addition to these pathways, we present six key drivers that are critical for successful institutionalization: strategic responsiveness to national health priorities, partnership with policymakers and other stakeholders, community ownership and involvement, monitoring and use of data, diversification of financial resources, and longevity of efforts.ConclusionWith additional research, we propose that this framework can contribute to program planning and policy making of donors, governments, and the NGO community in the institutionalization of community health strategies.

Having Peers and Becoming One: Collective Consciousness among Civil Society Actors in China

Based on a unique survey of non-governmental organization (NGO) practitioners from diverse backgrounds, the article examines how these NGO practitioners view their peers and people alike, and the interconnectedness, unity and solidarity of the NGO sector. The research has found that mutual awareness and trust is strong at the interpersonal level among NGO practitioners, yet their views on the collective existence of an NGO and activism community remain divided. In addition, preliminary statistical analysis shows that particular work experiences such as connections with other NGOs and participation in policy advocacy are associated with the optimism of a shared community of social activism. More importantly, the more one has—or feels one has—having peers across organizations, the more favorably one thinks of the whole activism community. Therefore, the key to ‘becoming a community’ for civil society in China lies in ‘having peers’ for individual activists and NGO practitioners.

A Managerial Dance to a Broken Systemic Tune: The Effects of Institutional Environment on the Performance of Aid Funded Projects in Developing Nations

Recent calls by foreign aid experts for aid donors to channel more of their aid funds through national governments stems from the fact that researchers lack the necessary data to ascertain whether nongovernmental organizations (NGOs) manage aid funds better than national governments do. Aid-funded projects are the result of a World Health Organization (WHO), World Bank, United Nations Development Program (UNDP), or some other organization’s assessment of a gap or problem in a developing country such as Ghana. Donors and the NGO community find out about the issue, a donor agency decides to fund the project, and the donor signs an agreement with the government of the developing country to implement the project. Some of the projects funded through NGOs and private consulting firms have been successfully completed, but many have failed. Some researchers blame this failure on factors that the implementation partners usually cannot control. This research investigates the factors that affect the implementation of aid-funded projects as seen through the eyes and experiences of NGO leaders who have led aid-funded projects in Ghana. Using qualitative research and grounded theory approach to analyze the data, we found that the macro and systemic issues referenced in various aid-effectiveness and aid-accountability literature are prevalent in most aspects of the aid-delivery process. Interestingly the main reasons behind aid-project failure tend to be managerial in nature. We conclude that implementation fails because of lack of alignment with the receiving government’s agenda, lack of collaboration with stakeholders, improper planning practices and lack of accountability.

Seeing the community's perspective through multiple emic and etic vistas.

Health impact assessment (HIA) researchers regularly use community input in their investigations to help them better understand local health issues. Community data is commonly associated with the lived experiences of local impacted residents known as 'emic' data. It is becoming more common practice for HIA researchers to access outside experts and stakeholders ('etic' data) during the community input phase of their investigations. Utilizing published international HIA data, I look at who HIA researchers invite when they seek to get 'community input' in their HIA investigations. The HIA database was generated from an internet investigation of published HIAs (in English) from 1999 to 2011 and focused particularly on single authored assessments that were conducted by governments, non-governmental organizations (NGOs) or universities. HIA researchers access a wide range of emic and etic community perspectives in their search for the 'community's view'. Government, NGO and university investigators access community perspectives differently, with university HIA researchers inviting more emic-oriented community vistas than both government and NGO researchers. University and government HIA investigators are more likely to invite multiple emic and etic community perspectives during their community participation projects than NGO researchers. NGO HIA investigators tend to either invite emic perspectives or etic perspectives for their community input with less mixing of the two views in a single project. The paper concludes with a discussion on how HIA researchers can frame the 'community's perspective' in their HIA investigations through a combination of both 'insider' and 'outsider' community input sampling strategies.

Anti-zivil-militärisch? Politik von deutschen entwicklungspolitischen Nichtregierungsorganisationen in und zu Afghanistan

Abstract Against civil-military cooperation? The policies of German NGOs in and about Afghanistan. Over the last few years, German non-governmental organisations (NGOs) have opposed the intents of the German government to place conditions on public project funding that aim to strengthen the cooperation between NGOs and the German armed forces operating in Afghanistan. Analysing NGOs’ critiques of civil-military cooperation, the author shows the ambiguities of NGOs’ declarations, which tend to oscillate between political abstinence and a critique of the military intervention. The author argues that while NGOs and their networks oppose direct civil-military cooperation at the local level, they avoid clear political position-making with regards to the broader project of international military intervention and state-building. The specific and contradictory political roles of foreign NGOs within the international project of regime change in Afghanistan are analysed and issues that NGOs should debate in order to clarify their political position, despite the probable cost of a common position within „the NGO community“, are introduced.

The effectiveness of an adolescent reproductive health education intervention in Uganda

Ugandan adolescents lack sufficient reproductive health knowledge, which accounts in part for the staggering rates of teen pregnancies and sexually transmitted (STI) infections in this population. This study aimed to (1) examine Ugandan adolescents' baseline STI and contraceptive knowledge; (2) determine whether this knowledge varies by demographic factors, prior sexual experience or school grade; and (3) evaluate the effectiveness of an educational program to increase and retain STI and contraceptive knowledge among Ugandan adolescents. This study surveyed 129 adolescents (ages 15-19) regarding knowledge of STIs and contraceptive methods at schools and community non-governmental organizations at three time points. Findings demonstrated that at baseline the mean test scores for contraceptive knowledge and STI knowledge were 44% and 72%, respectively. Participants in higher secondary school grade-levels had greater odds of having prior STI knowledge (OR=19.6, 95% CI 2.0-187.6); participants who had previously engaged in sex had greater odds of having prior contraceptive knowledge (OR=4.62, 95% CI 1.45-14.72). A higher grade level was not associated with better knowledge of contraception; and being sexually active was not associated with better knowledge of STI information. Participants' knowledge of STIs and contraceptives improved after the education session (p<0.001), and knowledge was retained 3-weeks later (p<0.001). Findings suggest that Ugandan adolescents do not have adequate education regarding contraceptive methods and that implementation of reproductive health modules by an outside party can be effective in improving knowledge.

Governments, Governance, and the “Lunatic Fringe”: The Resources for Tomorrow Conference and the Evolution of Environmentalism in Canada

Environmental non-governmental organizations (NGOs) have long played an important role in the evolution of environmentalism and environmental governance in Canada. Using the groundbreaking 1961 Resources for Tomorrow Conference as its entry point, this article explores the contributions made by such organizations to this federally initiated conference in light of their work during previous decades; their relationship to the Canadian state and to the evolution of its environmental institutions; and the ways in which the conference became a conduit for frustrations that further galvanized the NGO community, leading to the formation of some of the most influential environmental organizations in Canada today. In doing so, the article challenges current historiographic and theoretical frameworks that distinguish a unique “modern” or second-wave environmental movement associated with Rachel Carson, the baby boom generation, and the counterculture movement of the late 1960s and 1970s from an earlier period of conservation-oriented activity ending roughly in 1920 and that make light of the period between. As such, it makes the case for a considerable degree of continuity within the movement over the long term, for the importance of collaborative efforts between the state and the NGO sector, and for the centrality in NGO circles not of radicalism but of relatively conventional attitudes, practices, and social movement strategies.

Viral Load for HIV Treatment Failure Management: A Report of Eight Drug-Resistant Tuberculosis Cases Co-Infected with HIV Requiring Second-Line Antiretroviral Treatment in Mumbai, India

Dear Sir: We read with great interest the report by Satti H, McLaughlin MM, and Seung KJ describing six HIV/drug-resistant tuberculosis (HIV/DR-TB) co-infected patients who failed first-line antiretroviral treatment (ART) in Lesotho.1 We would like to share an experience treating similar patients in Mumbai, India. Although having a lower HIV prevalence compared with many African countries, India has the third largest population living with HIV, after South Africa and Nigeria, with an estimated 2,090,000 people affected in 2011.2 Furthermore, India has the highest burden of TB in the world, representing one-fifth (21%) of the global incidence. Unfortunately, India does not have national data on DR-TB prevalence, but a survey conducted in the States of Gujarat and Maharashtra in 2007 estimated the prevalence of DR-TB to be 3% in new cases and 12–17% in retreatment cases.3 Between October 2006 and July 2013, Medecins Sans Frontieres (MSF) treated 129 DR-TB patients co-infected with HIV at a clinic in Mumbai. The patients were referred to us from government ART centers, public-private ART centers, and a network of community non-governmental organizations. All HIV patients were monitored with viral load (VL) testing at least every 6 months, as recommended by Satti. Patients identified as having virological failure received adherence counseling and subsequently had the VL test rechecked at 3–6 months. Those in whom the VL test did not re-suppress were switched to a second-line ART regimen consisting of a protease inhibitor (PI) and suitable nucleoside(tide) reverse transcriptase inhibitors (NRTIs), based on genotype HIV resistance testing when necessary. Of the 129 DR-TB patients co-infected with HIV, 8 patients required second-line ART4; the median baseline CD4 count of the 8 patients before DR-TB treatment initiation was 102.5 cells/μL. Three of the 8 patients were on first-line ART at the time of DR-TB treatment initiation and had to be switched to second-line ART during the course of DR-TB treatment (Table 1). All 3 had a VL result > 5,000 copies/mL before the switch; subsequent VL testing showed a 2-log decrease in the two patients in whom a result was available. Table 1 CD4 count, viral load, and TB treatment response of patients on second-line ART In the six patients having a CD4 count available at the end of DR-TB treatment, five had an increase compared with baseline. Five out of eight patients had successful outcomes: 3 were cured and 2 successfully completed DR-TB treatment. Two patients were unfortunately lost to follow-up, and there was one death (Case 5). In this latter case, there was extensive pulmonary involvement and additional resistance of the TB strain to fluoroquinolones. We agree with the recommendation of Satti that VL testing be performed routinely in DR-TB patients co-infected with HIV. It allows for early detection of ART adherence problems, which has been shown in other reports to prevent an unnecessary switch to a second-line regimen with enhanced adherence support.5 In those in whom the VL result cannot be re-suppressed (i.e. caused by development of HIV drug resistance), an early switch to a second-line regimen is likely to increase the chances of a more successful outcome. We would like to reinforce an additional point that was implied in their Short Report, that DR-TB and HIV management be integrated in co-infected patients. Such patients are complicated and ideally should be managed in the same health facility by the same team of health care providers. At present, HIV VL testing is reserved only for suspected cases of treatment failure attending public ART centers in Mumbai and is not used for routine monitoring. Such an approach is likely to delay early detection of ART failure and contribute to the poor outcomes being seen in DR-TB patients co-infected with HIV.6 In this and other national HIV/ART programs not yet implementing routine VL testing, we ask that this be prioritized in HIV patients being treated for DR-TB. We also hope to see stronger collaboration between all HIV/ART and DR-TB programs with a view toward eventual integration of services for these complicated patients, to allow for better management.7

Celebrating Twenty Years of Progress: World Breastfeeding Week 2012

This year we are supporting and participating in activities in celebration of the 20th World Breastfeeding Week. This annual event is celebrated during the first week in August to commemorate the signing of the Innocenti Declaration, adopted at the World Health Organization/UNICEF Policymakers’ Meeting, ‘‘Breastfeeding in the 1990s: A Global Initiative,’’ held at the Spedale degli Innocenti, Florence, Italy, July 30–August 1, 1990. Thirty countries signed on, with the goal of reaching four operational targets by 1995: (1) appoint a national breastfeeding coordinator of appropriate authority and establish a multisectoral national breastfeeding committee composed of representatives from relevant government departments, nongovernmental organizations (NGOs), and health professional associations; (2) ensure that every facility providing maternity services fully practices all 10 of the Ten Steps to Successful Breastfeeding set out in the joint WHO/UNICEF statement ‘‘Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services’’; (3) take action to give effect to the principles and aim of all Articles of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly resolutions in their entirety; and (4) enact imaginative legislation protecting the breastfeeding rights of working women and established means for its enforcement. The Innocenti Declaration also called upon international NGOs to draw up action strategies for protecting, promoting, and supporting breastfeeding, support national situation analyses and development of goals, and en courage and support national authorities in planning, implementing, monitoring, and evaluating their breastfeeding policies. Mr. James Grant, then Director of UNICEF, called upon the NGO community to organize in this regard, and the World Alliance for Breastfeeding Action (WABA) was born. One of WABA’s first ground-breaking acts was to establish an annual World Breastfeeding Week: a time for action, a time for advocacy, a time for advancing support for breastfeeding. Each year, a different theme is chosen. This ongoing support, the increasing implementation of all four operational targets, the steady flow of evidence showing the vital importance of breastfeeding, and the fact that breastfeeding rates were shown to be responsive to programs of action, all contributed to a call for The Global Strategy for Infant and Young Child Feeding, which was endorsed by WBW 2012 image courtesy of WABA

Cross Roads or Cross Purposes? Tensions Between Military and Humanitarian Providers

In October 2001, then-Secretary of State Colin Powell addressed a conference of humanitarian nongovernmental organizations (NGOs) in Washington, D.C. There, he remarked want you to know that I have made it clear to my staff here and to all of our ambassadors around the world that I am serious about making sure we have the best relationship with the NGOs who are such a force multiplier for us, such an important part of our combat team. (1) Although his purpose in this address was undoubtedly to build a foundation for a whole-of-nation effort to promote democracy, respect for human rights, and the elimination of terrorism, the secretary's speech had the opposite effect, angering many of the conference's participants who felt that the US Government was seeking to co-opt their organizations by making them mere ancillaries to the war effort. In 2006 to 2007, Army Lieutenant Colonel James L. Cook was the C J3 (Deputy for Plans and Operations) for Combined Joint Task Force (CJTF) 76, covering Regional Command (RC) South and RC East in Afghanistan. His command controlled most of the Provincial Reconstruction Teams (PRTs), and all of the American PRTs operating in those areas of responsibility. Troubling to LTC Cook was the level of redundancy of aid and assistance programs undertaken by the military, government agencies, and the NGO community. He was confused to why: as operators, it was so difficult to get everyone to row together and divide responsibilities to most efficiently and effectively use the limited resources at hand. (2) Although he found levels of access to and cooperation with NGOs varied from project to project and NGO to NGO, Cook felt area-wide communication and cooperation were less than he thought possible and NGOs were (largely) unresponsive to his staff's efforts to streamline the distribution of reconstruction and aid monies. Introduction Like most military and foreign policy professionals, Secretary Powell and LTC Cook have a genuine interest in helping those in need. Alleviating suffering is not their only interest however. The Departments of State and Defense are arms of the United States government and are thus responsible to the nation and its people for advancing their interests well for meeting the needs of those affected by tragedy. Indeed, there is a hierarchy of interests that are served by government-sponsored humanitarian missions. First, advance the goals of the nation, and, second, deliver aid to those in need. There is nothing cynical or hypocritical about this hierarchy. As the previous passages reflect, rather than seeing these national and humanitarian ends conflicting, both Secretary Powell and LTC Cook believed these two goals were in harmony--one supports the other. As the respect for human rights and dignity from policy practitioners is genuine, they believe their common cause with their humanitarian NGO counterparts should serve a basis for a smooth and unproblematic partnership. True, the humanitarians might not share their hierarchy of interests, the latter may privilege the interests of those in need of aid above the interests of the nations that deliver it. But, the government practitioner sees no conflict between serving these two interests, this fact ought not disrupt prospects for cooperation. The continued unevenness in civil-military relations between militaries and nongovernmental aid-givers, sometimes cooperative, often uncooperative (even hostile), thus continues to confuse and frustrate government agents. In fact, the root of such problems stem from the fact that many in the policy community fail to appreciate that humanitarians also have a hierarchy of interests. Humanitarians have historically been concerned with humanitarianism an end much a means, because the practice of humanitarianism redeems the aid-giver much it comforts the recipient--or, more precisely, the aid-giver is redeemed through providing comfort to others. …

Ambulatory Multi-Drug Resistant Tuberculosis Treatment Outcomes in a Cohort of HIV-Infected Patients in a Slum Setting in Mumbai, India

BackgroundIndia carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India.MethodsHIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment.ResultsBetween May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment.ConclusionsDespite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a slum setting in India. Rapid scale-up of both ART and second-line treatment for MDR-TB is needed to ensure survival of co-infected patients and mitigate this growing epidemic.

HIV, Sex Work, and Civil Society in China

Harm reduction programs for sex workers have been hampered by the prioritization of law enforcement over AIDS prevention. For example, the April 2010 "strike-hard" campaign against prostitution in Beijing, during which bars, nightclubs, saunas, and karaoke bars were raided, created an atmosphere that critically impeded human immunodeficiency virus (HIV) outreach activities for sex workers. In China, criminalization has limited the growth of a coherent and cohesive set of nongovernmental organization (NGO) actors working with sex workers to prevent HIV infection. Compared with other risk groups for HIV sexual transmission, such as men who have sex with men, the NGO community for sex workers is fragmented and poorly coordinated with government efforts, and basic rights for sex workers are often violated. This article examines civil society groups working on AIDS prevention and care for female sex workers in China and reviews constraints to their operations. China's HIV prevention programs for sex workers are compared with sex worker HIV prevention in other Asian states where more well-developed NGOs exist and criminalization has been better balanced with harm reduction approaches, and recommendations are offered on improving China's policies and programs.