Alister Munthali

Youth, mobility and mobile phones in Africa: findings from a three-country study

The penetration of mobile phones into sub-Saharan Africa has occurred with amazing rapidity: for many young people, they now represent a very significant element of their daily life. This paper explores usage and perceived impacts among young people aged c. 9–18 years in three countries: Ghana, Malawi and South Africa. Our evidence comes from intensive qualitative research with young people, their parents, teachers and other key informants (in-depth interviews, focus groups and school essays) and a follow-up questionnaire survey administered to nearly 3000 young people in 24 study sites. The study was conducted in eight different sites in each country (i.e. urban, peri-urban, rural and remote rural sites in each of two agro-ecological zones), enabling comparison of experiences in diverse spatial contexts. The evidence, collected within a broader research study of child mobility, allows us to examine current patterns of usage among young people with particular attention to the way these are emerging in different locational contexts and to explore connections between young peoples phone usage, virtual and physical mobilities and broader implications for social change. The issues of gender and inter-generational relations are important elements in this account.

Where dogs, ghosts and lions roam: learning from mobile ethnographies on the journey from school

This paper draws on mobility research conducted with children in three countries: Ghana, Malawi and South Africa. It has two interlinked aims: to highlight the potential that mobile interviews can offer in research with young people, especially in research contexts where the main focus is on mobility and its impacts, and to contribute empirical evidence regarding the significance of everyday mobility to young peoples lives and future life chances in sub-Saharan Africa. During the pilot phase of our research project on children, transport and mobility, the authors undertook walks home from school with teenage children1 in four different research sites: three remote rural, one peri-urban. As the children walked (usually over a distance of around 5 km) their stories of home, of school and of the environment in-between, gradually unfolded. The lived experiences narrated during these journeys offer considerable insights into the daily lives, fears and hopes of the young people concerned, and present a range of issues for further research as our study extends into its main phase.

Factors Shaping Initial Decision-Making to Self-test Amongst Cohabiting Couples in Urban Blantyre, Malawi

In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one’s partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.

Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries

There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

Inclusion and Human Rights in Health Policies: Comparative and Benchmarking Analysis of 51 Policies from Malawi, Sudan, South Africa and Namibia

While many health services strive to be equitable, accessible and inclusive, peoples’ right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed – EquiFrame – to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development.

Core Concepts of Human Rights and Inclusion of Vulnerable Groups in the Disability and Rehabilitation Policies of Malawi, Namibia, Sudan, and South Africa

In recent decades, there has been a push to incorporate the World Health Organization “Health for All” principles in national, regional, and local health policy documents. However, there is still no methodology guiding the appraisal of such policies with regard to the extent that they address social inclusion. In this article, the authors report on the development of EquiFrame, a novel policy analysis framework that was used to evaluate the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. The policies were assessed in terms of their commitment to 21 predefined core concepts of human rights and inclusion of 12 vulnerable groups. Substantial variability was identified in the degree to which the core concepts and vulnerable groups were featured in these policy documents. The overall summary rankings for the disability policies of the countries studied were as follows: Namibia–High, Malawi–Low, and Sudan–Low. The rehabilitation policy of South Africa was ranked as Low. The results support the idea that adequate disability and rehabilitation policies remain mostly undefined. EquiFrame may offer a useful methodology for evaluating and comparing human rights and social inclusion across policy documents.

Taking the long view : temporal considerations in the ethics of children's research activity and knowledge production.

Children are increasingly engaged in the research process as generators of knowledge, but little is known about the impacts on childrens lives, especially in the longer term. As part of a study on childrens mobility in Ghana, Malawi and South Africa, 70 child researchers received training to conduct peer research in their own communities. Evaluations at the time of the project suggested largely positive impacts on the child researchers: increased confidence, acquisition of useful skills and expanded social networks; however, in some cases, these were tempered with concerns about the effect on schoolwork. In the follow-up interviews 2 years later, several young Ghanaian researchers reported tangible benefits from the research activity for academic work and seeking employment, while negative impacts were largely forgotten. This study highlights the unforeseeable consequences of research participation on childrens lives as they unfold in unpredictable ways and underscores the temporal nature of childrens engagement in research.

Responding to Risk: Circumcision, Information, and HIV Prevention

Understanding behavioral responses to changes in actual or perceived risk is important because risk-reduction goals can be undermined by risk-compensating behavior. This paper examines the response to new information about the risk of HIV infection. Approximately 1,200 circumcised and uncircumcised men in rural Malawi are randomly informed that male circumcision reduces the HIV transmission rate, predicting asymmetric behavioral responses. We find no evidence that the information induces circumcised men to engage in riskier sex while uncircumcised men practice safer sex in response to the information. There were no significant effects of the information on child circumcisions after one year.

The evil circle of poverty: a qualitative study of malaria and disability

BackgroundThis article discusses the link between disability and malaria in a poor rural setting. Global malaria programmes and rehabilitation programmes are organized as vertical and separate programmes, and as such they focus on prevention, cure and control, and disability respectively. When looking at specific conditions and illnesses, the impairing long-term consequences of illness incidents during childhood are not questioned.MethodsThe study design was ethnographic with an open, exploratory approach. Data were collected in Mangochi District in Malawi through qualitative in-depth interviews and participant observation.ResultsDespite a local-based health service system, people living in poor rural areas are confronted with a multitude of barriers when accessing malaria prevention and treatment. Lack of skilled health personnel and equipment add to the general burden of poverty: insufficient knowledge about health care, problems connected to accessing the health facility in time, insufficient initiatives to prevent malaria attacks, and a general lack of attention to the long term disabling effects of a malaria attack.ConclusionsThis study points to the importance of building malaria programmes, research and statistics that take into consideration the consequences of permanent impairment after a malaria attack, as well as the context of poverty in which they often occur. In order to do so, one needs to develop methods for detecting people whose disabilities are a direct result of not having received health services after a malaria episode. This may be done through qualitative approaches in local communities and should also be supplemented by suitable surveys in order to estimate the problem on a larger scale.

Core concepts of human rights and inclusion of vulnerable groups in the mental health policies of Malawi, Namibia and Sudan.

BackgroundOne of the most crucial steps towards delivering judicious and comprehensive mental health care is the formulation of a policy and plan that will navigate mental health systems. For policy-makers, the challenges of a high-quality mental health system are considerable: the provision of mental health services to all who need them, in an equitable way, in a mode that promotes human rights and health outcomes.MethodEquiFrame, a novel policy analysis framework, was used to evaluate the mental health policies of Malawi, Namibia, and Sudan. The health policies were assessed in terms of their coverage of 21 predefined Core Concepts of human rights (Core Concept Coverage), their stated quality of commitment to said Core Concepts (Core Concept Quality), and their inclusion of 12 Vulnerable Groups (Vulnerable Group Coverage). In relation to these summary indices, each policy was also assigned an Overall Summary Ranking, in terms of it being of High, Moderate, or Low quality.ResultsSubstantial variability was identified across EquiFrame’s summary indices for the mental health policies of Malawi, Namibia, and Sudan. However, all three mental health policies scored high on Core Concept Coverage. Particularly noteworthy was the Sudanese policy, which scored 86% on Core Concept Coverage, and 92% on Vulnerable Group Coverage. Particular deficits were evident in the Malawian mental health policy, which scored 33% on Vulnerable Group Coverage and 47% on Core Concept Quality, and was assigned an Overall Summary Ranking of Low accordingly. The Overall Summary Ranking for the Namibian Mental Health Policy was High; for the Sudanese Mental Health Policy was Moderate; and for the Malawian Mental Health Policy was Low.ConclusionsIf human rights and equity underpin policy formation, it is more likely that they will be inculcated in health service delivery. EquiFrame may provide a novel and valuable tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, a key practical step in the successful realization of the Millennium Development Goals.