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Yumkella F.,Dalan Development Consultants of Freetown | Diaz T.,Knowledge Management Implementation Research Unit
Health Policy and Planning | Year: 2014

Background Sierra Leone has emerged from civil war but remains in the lowest tier of the human development index. While significant health reforms, such as the removal of user fees, aim to increase access to services, little is known about how families navigate a plural health system in seeking health care for sick children. This research aims to build on recent care-seeking literature that emphasizes a shift from static supply-and-demand paradigms towards more nuanced understandings, which account for the role of household agency and social support in navigating a landscape of options. Methods A rapid ethnographic assessment was conducted in villages near and far from facilities across four districts: Kambia, Kailahun, Pujehun and Tonkolili. In total, 36 focus group discussions and 64 in-depth interviews were completed in 12 villages. Structured observation in each village detailed sources of health care. Results When a child becomes sick, households work within their geographic, social and financial context to seek care from sources including home treatment, herbalists, religious healers, drug peddlers and facility-based providers. Pathways vary, but respondents living closer to facilities emphasized facility care compared with those living further away, who take multi-pronged approaches. Beyond factors linked to the location and type of healthcare provision, social networks and collaboration within and across families determine how best to care for a sick child and can contribute to (or hinder) the mobilization of resources necessary to access care. Husbands play a particularly critical role in mobilizing funds and facilitating transport to facilities. Conclusion Caregivers in Sierra Leone have endured in the absence of adequate health care for decades: their resourcefulness in devising multiple strategies for care must be recognized and integrated into the service delivery reforms that are making health care increasingly available. © 2013 The Author. All rights reserved.


Diaz T.,Knowledge Management Implementation Research Unit | Noordam A.C.,Knowledge Management Implementation Research Unit | Dalmiya N.,Knowledge Management Implementation Research Unit
Food and Nutrition Bulletin | Year: 2013

Background. In efforts to meet the Millennium Development Goal for mortality among children under 5 years of age, countries require strategies for covering hard-toreach and older children who are often missed by routine, fixed-site health services. Objective. To document the evolution of Child Health Days (CHDs), designed as regular events for the delivery of health and nutrition services to children under the age of five. Methods. We extracted information on service delivery strategies and codelivered interventions for the period 1999 to 2010 from global monitoring databases for vitamin A and immunization. Results. Our data illustrate a dramatic rise in CHDs over the decade: only two countries held CHDs in 1999; in 2010, 96 CHDs were conducted in 51 countries. Reliance on CHDs has been particularly marked in sub-Saharan Africa, where they are increasingly used to deliver five or more services per event. Whereas early CHDs were largely defined by codelivery of vitamin A, immunizations, and deworming, they have since evolved into diverse packages including services such as water purification tablets and screening for severe malnutrition. Conclusions. The scale-up of CHDs is helping countries to achieve high and equitable coverage of essential health and nutrition services. Future research should consider whether the increasingly diverse services delivered via CHDs are guided by epidemiologic considerations, and whether the rising number of codelivered interventions is affecting coverage performance or service quality. Guidance is also needed to ensure that CHDs are implemented as part of systematic efforts to improve health systems. © 2013, The Nevin Scrimshaw International Nutrition Foundation.


Zembe-Mkabile W.,Health Systems Research Unit | Ramokolo V.,Health Systems Research Unit | Sanders D.,University of the Western Cape | Jackson D.,University of the Western Cape | And 3 more authors.
Public Health Nutrition | Year: 2015

Objective: Cash transfer programmes targeting children are considered an effective strategy for addressing child poverty and for improving child health outcomes in developing countries. In South Africa, the Child Support Grant (CSG) is the largest cash transfer programme targeting children from poor households. The present paper investigates the association of the duration of CSG receipt with child growth at 2 years in three diverse areas of South Africa. Design: The study analysed data on CSG receipt and anthropometric measurements from children. Predictors of stunting were assessed using a backward regression model. Setting: Paarl (peri-urban), Rietvlei (rural) and Umlazi (urban township), South Africa, 2008. Subjects: Children (n 746), median age 22 months. Results: High rates of stunting were observed in Umlazi (28 %), Rietvlei (20 %) and Paarl (17 %). Duration of CSG receipt had no effect on stunting. HIV exposure (adjusted OR=2·30; 95 % CI 1·31, 4·03) and low birth weight (adjusted=OR 2·01, 95 % CI 1·02, 3·96) were associated with stunting, and maternal education had a protective effect on stunting. Conclusions: Our findings suggest that, despite the presence of the CSG, high rates of stunting among poor children continue unabated in South Africa. We argue that the effect of the CSG on nutritional status may have been eroded by food price inflation and limited progress in the provision of other important interventions and social services. Copyright © The Authors 2015

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