Mayeh Omar

Mental Health Policy Development and Implementation in Four African Countries

The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

Traditional gender roles, forced sex and HIV in Zimbabwean marriages

Little is known on how forced sex contributes to the sexual transmission of HIV in marriage. This paper describes traditional gender norms surrounding forced sex in Zimbabwean marriage. Data were collected from 4 focus group discussions and 36 in-depth interviews with married women and men in Harare. Results indicate that hegemonic masculinity characterised by a perceived entitlement to sex, male dominance and being a provider contributed to forced sex in marriage. A femininity characterised by a tolerance of marital rape, the desire to please the husband and submission contributed to women experiencing forced sex. An alternative femininity characterised by sexual pleasure-seeking contributed to women forcing their spouses to have sex. Future HIV interventions must go beyond narrowly advocating for safer sex within marriage and instead address practices that increase risk as well as promote positive marital relationship needs such as mutual respect, love and friendship.

Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions

Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage womens safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.

A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India

BackgroundA major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes.MethodA rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra.ResultsAvailability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients.ConclusionFurther investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand.

Health system decentralisation in Nepal: identifying the issues

PURPOSE The purpose of this paper is to describe and discuss policy analysis in Nepal and review the wide range of choices feasible in decentralisation decision making. DESIGN/METHODOLOGY/APPROACH In this paper an iterative qualitative method was developed and used in the research, which consisted of focus group interviews, key informant interviews, document analysis, including descriptive statistics, and analysis of the policy context. Participants in the research reflected the urban/rural mix of districts and the geography of Nepal. Analysis combined transcribed interviews with findings from document searches and analysis of the policy context. Coding was pre-determined during the training workshop and further codes were generated during and after the fieldwork. FINDINGS The paper finds that Nepal is in the process of decentralising public services from the central level to the local level, particularly to local bodies: District Development Committees (DDCs), Village Development Committees (VDCs) and Municipalities. Key contextual factors referred to are the overall structure of decentralisation, the social context of poverty and the political instability leading to a fluid political situation characterised by political tension, armed conflict, controversies and agreements while carrying out the research. The key issues identified and discussed in the paper are the policy process leading to decentralisation, the organisational structure and tension in the proposed system, the systems of resource generation, allocation, planning and management and lastly the forms of accountability, participation, public-private relations and collaborative strategies. ORIGINALITY/VALUE The paper discusses the challenges faced in conducting such a policy analysis, the broad ranging and unremitting nature of the decentralisation process, and the contextual setting of the process of change.

In‐country capacity development of a training institute: an Iranian experience

PURPOSE The purpose of this paper is to review the Government initiative for developing the in-country capacity of the National Public Health Management Centre (NPMC) in Tabriz. The UNDP definition of capacity has been used as a framework for assessment with the primary focus of the current assessment being on the training component. DESIGN/METHODOLOGY/APPROACH The pape shows that Iran, which is a lower-middle income country, has a network of training institutions for both pre-service and continuing education of its human resources in health. This collaborative initiative between NPMC, Nuffield Centre for International Health and Development (NCIHD) and World Health Organization (WHO), attempted to create conditions for designing, organising and conducting a training programme in health planning and management for mid-level health managers in Iran. FINDINGS The paper finds that the experience of capacity development through training, described here, is in contrast with usual practice, where candidates are sent abroad for training. Overall, the process for developing in-country capacity of a local institute by a foreign institute was well thought out. However, there are some lessons to be learned from the process. ORIGINALITY/VALUE The paper shows that capacity has been built in NPMC for organising in-country short course on health planning and management for health sector reform. The paper concludes by arguing that, in order to sustain these training programmes over a long period of time, in addition to including training in its mandate, NPMC should: consider networking with allied institutions in the country and beyond for sharing knowledge; and make twinning arrangements with a foreign institute for continuously upgrading the knowledge and skills of its trainers.

Community entry ‐ an essential component of participation

Sees community entry as a prelude to any action that will take place in a true partnership with the community. Lists a series of steps involved in achieving community entry drawn from a project in Pakistan. Considers the role of the participatory worker and project management team in terms of meetings, discussions and the development of individual relationships.

Shaping the health of the nation: development of human resources in Eritrea.

Looks at human resources (HR) issues with regard to the health care system in Eritrea, the newest nation in Africa with a population of 3.5 million. Notes the problems of poor infrastructure, high mortality rates and poverty. Considers the present situation and future requirements in terms of HR. Features programmes being established aimed at bridging this gap and looks particularly at initiatives aimed at enabling ex-combatants who have wartime health care experience to train further as health workers.

Concurrent sexual partnerships among married Zimbabweans - implications for HIV prevention.

Background Concurrent sexual partnerships play a key role in sustaining the HIV epidemic in Zimbabwe. Married couples are at an increased risk of contracting HIV from sexual networks produced by concurrent sexual partnerships. Addressing these partnerships is an international HIV prevention priority. Methods Our qualitative study presents the socioeconomic factors that contribute to the occurrence of concurrent sexual partnerships among married people in Zimbabwe. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008 to understand the organizations of concurrent sexual partnerships. Data were analyzed using framework analysis. Results Our study indicates that relationship dissatisfaction played a key role in the engagement of concurrent sexual partnerships. Depending on the source of the dissatisfaction, there were four possible types of concurrent sexual relationships that were formed: sex worker, casual partner, regular girlfriend or informal polygyny which was referred to as “small house”. These relationships had different levels of intimacy, which had a bearing on practicing safer sex. Participants described three characteristics of hegemonic masculinity that contributed to the sources of dissatisfaction leading to concurrent sexual activity. Similarly, various aspects of emphasized femininity were described as creating opportunities for the occurrence of concurrent sexual relationships. Economic status was also listed as a factor that contributed to the occurrence of concurrent sexual partnerships. Conclusion Marital dissatisfaction was indicated as a contributing factor to the occurrence of concurrent sexual relationships. There were several reports of satisfying marital relationships in which affairs did not occur. Lessons from these marriages can be made part of future HIV prevention interventions targeted at preventing concurrent sexual partnerships by married couples.

Filling the assessment gap: using a learning portfolio in international development courses.

PURPOSE The purpose of this research is to describe an action research project that proposed, monitored and evaluated the introduction of a learning portfolio used to replace examinations that were formerly used to assess the core courses. DESIGN/METHODOLOGY/APPROACH An action research project was undertaken to find out whether the introduction of a portfolio was successful and what could be improved in the process of its implementation. FINDINGS The findings indicate that portfolios are effective to support and assess the academic development of international students. ORIGINALITY/VALUE The introduction of a portfolio to replace written examinations in the NCIHD was welcomed by all concerned.