Elijah Bisung

Social capital, collective action and access to water in rural Kenya.

Globally, an estimated 748 million people remain without access to improved sources of drinking water and close to 1 billion people practice open defecation (WHO/UNICEF, 2014). The lack of access to safe water and adequate sanitation presents significant health and development challenges to individuals and communities, especially in low and middle income countries. Recent research indicates that aside from financial challenges, the lack of social capital is a barrier to collective action for community based water and sanitation initiatives (Levison et al., 2011; Bisung and Elliott, 2014). This paper reports results of a case study on the relationships between elements of social capital and participation in collective action in the context of addressing water and sanitation issues in the lakeshore village of Usoma, Western Kenya. The paper uses household data (N=485, 91% response rate) collected using a modified version of the social capital assessment tool (Krishna and Shrader, 2000). Findings suggest that investment in building social capital may have some contextual benefits for collective action to address common environmental challenges. These findings can inform policy interventions and practice in water and sanitation delivery in low and middle income countries, environmental health promotion and community development.

Dreaming of toilets: using photovoice to explore knowledge, attitudes and practices around water-health linkages in rural Kenya.

As part of a knowledge, attitudes, practices and empowerment (KAPE) project implemented by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) in the Lake Victoria Basin, this paper reports findings from a photovoice study with women in Usoma, a lakeshore community in Western Kenya. Drawing on ecosocial and political ecology theory, findings reveal that access to water, perceptions and practices were shaped by ecological and broader structural factors. Further, collective actions to improve access were constrained by institutional and economic structures, thus (re)enforcing inequalities.

Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: a scoping review

The lack of access to safe water and adequate sanitation has implications for the psychosocial well-being of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.

One community’s journey to lobby for water in an environment of privatized water: is Usoma too poor for the pro-poor program?

Achieving the proposed water, sanitation, and hygiene (WASH) post-MDG goals will require targeted measures if the human right to water and sanitation is ever to be realized. Particularly in rural areas, among urban poor populations and marginalized communities where access remains low, the human right to water and sanitation is an important vehicle to raise attention to inequalities in access. In this paper, we explore the journey of Usoma, a small community in Western Kenya, as they move toward the realization of a human right to water and sanitation. In the face of international pressure for increasingly privatized water and sanitation services that emphasize efficiency and financial sustainability, we conclude that translating the human right to water and sanitation requires adequate commitment to ‘pro-poor’ policies, innovative financing models, monitoring of water service providers, and stakeholder engagement at all levels of government. Only in this way will access to water and sanitation be realized as a human right.

''It's Like a Disease'': Women's perceptions of caesarean sections in Ghana's Upper West Region

PROBLEM While caesarean sections in developing contexts act as a marker for access to skilled care, little is known about the health outcomes of caesarean sections. With calls for a more in depth understanding of womens perceptions of this procedure in resource poor settings, this paper explores womens perceptions and experiences of caesarean birth in the context of Ghanas Maternal Exemption Policy of the National Health Insurance Scheme in the Upper West Region. METHODS A qualitative study using 10 focus group discussions and 30 in depth interviews of mothers and pregnant women were conducted. The results were thematically analysed. FINDINGS Drawing on theories of feminist geography and embodiment, the results suggest most women perceive caesarean section birth as highly problematic, acting as a long term disease, which hinders their ability to engage in economic activities and care for their children. In the context of the Maternal Exemption Policy, caesarean section birth restricts a womans ability to secure further health insurance for themselves and newborn child, leaving long term access to health care uncertain. Findings also suggest long term repercussions of caesarean sections may go beyond the physical health of the mother and child to include other socio-cultural and contextual challenges. DISCUSSION Accordingly, caesarean sections position women in a multifaceted situation of vulnerability. This underscores the need for context appropriate maternal health programmes in developing countries.

Book review: Henderson, Jeffrey. 2011: East Asian transformation: On the political economy of dynamism, governance and crisis and Payne, Anthony and Nicola Phillips. 2010: Development

Henderson, Jeffrey. 2011: East Asian transformation: On the political economy of dynamism, governance and crisis. Abingdon and New York: Routledge. 184 pp. £28.99 paperback. £98.04 hardback. ISBN: 9780415547918 hardback. ISBN: 9780415547925 (paperback), ISBN: 978020383313 (e-book). Payne, Anthony and Nicola Phillips. 2010: Development. Cambridge, UK: Polity Press (Key Concepts in the Social Sciences Series). 196 pp. £15.99 paperback. £50 hardback. ISBN: 9780745630670 (hardback), ISBN: 9780745630685 (paperback).