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Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

National response to disability and HIV in Eastern and Southern Africa

HANASS-HANCOCK, Jill
GRANT, Kitty
February 2010

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Although people with disabilities are often at increased risk of exposure to HIV, this policy brief outlines that less than half of the national strategic plans in Eastern and Southern Africa recognise disability as an issue of concern. Recommendations are provided to governments and civil society on how to address the issue effectively. This policy brief would be useful to people interested in HIV policies in Africa

Disability in national strategic plans on HIV and AIDS : a review on the national response to the interrelations of disability and HIV in eastern and southern Africa|Final report

GRANT, Kitty
STRODE, Ann
HANNASS-HANCOCK, Jill
December 2009

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This report examines national AIDS and HIV strategic plans (NSPs) in eastern and southern Africa and includes findings, discussions and best practice examples on the integration of disability throughout the countries. "Generally, the findings of the report show that less than 50% of the countries in Eastern and Southern Africa recognise disability as an issue of concern, or specifically recognise the vulnerability of people with disabilities to HIV and AIDS within their NSPs. Furthermore, it found that even where countries have recognised disability as an issue, there is limited specific guidance within the NSP on HIV-related service provision to meet the needs of people with disabilities. Only one country, South Africa, showed extensive integration of disability into the various focus areas of its NSP." The report concludes with recommendations and provides detailed appendices of national reports for each country surveyed

The price of exclusion : the economic consequences of excluding people with disabilities from the world of work

BUCKUP, Sebastian
2009

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People with disabilities can work and contribute to the economy, just like people without disabilities. This report highlights the macro-economic cost of excluding people with disabilities from the labour market. The study quantifies the economic losses of ten countries in Asia and Africa and presents the outcomes. It would be useful to people interested economic and employment issues for people with disabilities

Supporting HIV-positive teachers in East and Southern Africa

MALLOURIS, Chrstoforos
BOLER, Tania
September 2007

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This report provides an overview of the impact of HIV on teachers and the specific issues HIV-positive teachers face. It also summarises support mechanisms for teachers with HIV and presents key conclusions and recommendations from the consultation regarding how the education sector can support HIV-positive teachers. The report is the result of a consultation involving a range of different stakeholders including representatives of Ministries of Education, teachers' unions and HIV-positive teachers' networks from six countries in East and Southern Africa

HIV/AIDS communication in selected African countries : interventions, reponses and possibilities

PARKER, Warren
RAU, Asta
PEPPA, Penny
2007

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This review looks at communication activities around HIV prevention in 11 countires in South and East Africa operating in 2006 at a national level. It considers the variations in HIV epidemiology between countries, and the heterogeneity within them, and examines the different approaches to communication that are used. The country summaries include a synopsis of the epidemiology, indicators of knowledge, behaviour and service uptake and information about HIV and AIDS prevention communication, activities, approaches and funding

Pain relieving drugs in 12 African PEPFAR countries : mapping current providers, identifying current challenges, and enabling expansion of pain control provision in the management of HIV/AIDS

HARDING, Richard
et al
January 2007

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This study aims to identify current opioid prescribing services and regulatory bodies within 12 African PEPFAR (Presidents Emergency Plan for AIDS Relief ) countries, and to examine the barriers to, and appraise the potential for, expansion in the number of opioid providers, for people with HIV and AIDS according to the World Health Organization pain ladder. It concludes that while there are common issues raised by services and International Narcotics Control Board competent authorities, it is clear that these key stakeholders have concerns regarding the potential roll-out of opioids

Challenges of care : VSO-RAISA regional conference 2007 report back

HAMILTON, Robin
PORTER, Stephen
2007

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"The aim of the conference was to bring together stakeholders from different sectors, in order to create a forum for discussing innovative solutions to emerging issues affecting caregivers in community based organisations. Objectives included focusing on the challenges of care to women and children, identifying good home-based care practices, discussing policy and legal frameworks for home-based care, raising awareness of caregivers’ needs, exploring how to engage men in home-based care, and establishing networks for lobbying and advocacy"

Getting started! : running a junior farmer field and life school|Empowering orphans and vulnerable children living in a world with HIV and AIDS

WIEGERS, Esther
HILL, Catherine
COLBERT, Patricia
2007

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This manual was developed from the experiences of a number of communities and organisations in southern and eastern Africa in creating Junior Farmer Field and Life Schools as a response to the growing number of orphans and vulnerable children. For many reasons these children more likely than other orphans to be at risk from malnutrition, disease, abuse, stigmatisation and sexual exploitation. The risk of sexual exploitation is particularly significant for those left alone to cope with poverty and who are forced to adopt adult roles and ensure food for the rest of the family. As parents and family members become ill, children take on greater domestic, agricultural and income generating responsibilities. HIV and AIDS has a particular impact on girls who are left to care for ailing parents, or who have to become the heads of households upon the death of caregivers. Also, as many parents are dying at a young age orphaned children are growing up without the necessary knowledge and skills for their future livelihood

Social protection : how important are the national plans of action for orphans and vulnerable children?

SABATES-WHEELER, Rachel
PELHAM, Lissa
October 2006

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This is a review of 14 national plans of action (NPA), or in the absence of a NPA, outputs from the rapid assessment analysis and action planning (RAAAP) work for orphans and children made vulnerable by HIV/AIDS. It analyses the way that issues of social protection are incorporated into these plans and highlights areas within the plans where social protection activity may be needed to achieve stated outcomes. There are also country by country summaries of the social protection content of each NPA

Using social transfers to improve human development

DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID)
February 2006

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This note provides an introduction to how social transfers - particularly cash transfers and vouchers - can improve human development, particularly for the extreme poor and socially excluded

Civil society involvement in rapid assessment, analysis and action planning (RAAAP) for orphans and vulnerable children : an independent review

GOSLING, Louisa
July 2005

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This review explores civil society organisations' experiences of the Rapid Assessement, Analysis and Action Planning (RAAAP) process - an initiative launched by USAID, UNICEF, UNAIDS, and the World Food Program - for orphans and other vulnerable children in November 2003. It comprises of a review of where civil society organisations were involved and where they were not and an overview of the process of their invovlement. It also offers recommendations for existing and future RAAAPs to ensure greater invovlement of civil society organisations, and includes individual reports on the 16 sub-Saharan African countries invovled in the first round of RAAAP in 2004

USAID project profiles : children affected by HIV/AIDS

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
January 2005

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This document presents profiles of 114 projects (90 country-specific, 12 regional, and 12 global) funded by USAID. It includes a section on USAID projects that support access to education in Africa. The project profiles include the names of implementing organisations, funding periods and amounts, objectives, strategies, key accomplishments, priority activities for the year ahead, and materials and tools available to other projects that can help meet the needs of children and youth affected by HIV and AIDS. The diversity of these projects demonstrates the US government's efforts to meet the wide variety of needs of children and youth affected by HIV and AIDS. Approaches vary in both strategy and scale. The vast majority of projects work with communities to identify opportunities that strengthen existing resources without undermining local ownership. In many places, communities are already mobilised and have systems in place to identify, protect, and provide basic necessities to the most vulnerable children. USAID supports the strengthening and monitoring of these existing activities

Mapping malaria risk in Africa

MAPPING MALARIA RISK IN AFRICA / ATLAS DU RISKE DE LA MALARIA EN AFRIQUE (MARA/ARMA)
December 2004

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This site presents maps of malaria risk and endemicity (the presence of malaria) in Africa, drawing on published and unpublished data, and through spatial modelling of malaria distribution, seasonality and endemicity. Many factors, especially endemicity, affect the choice of control methods. In the absence of such data it is impossible to rationalize the allocation of limited resources for malaria control. This site presents an opportunity to rethink endemicity and how we may map malaria risk in order to better support planning and programming of malaria control

Disability and rehabilitation status : review of disability issues and rehabilitation services in 29 African countries

GIANNELLLI, Massimo
DEEPAK, Sunil
Eds
December 2004

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This report provides information related to disability issues and rehabilitation services, provided by 29 countries of Africa, and includes demographics, the presence of national policies and NGOs. The report is divided into the following three parts: a global review of information, the country profiles and a summary table of the information provided in individual countries. This report is useful for people interested in disability and rehabilitation services in Africa

Orphans and vulnerable children : taking action, building support. 2004 regional conference report back

VOLUNTARY SERVICE OVERSEAS REGIONAL AIDS INITIATIVE OF SOUTHERN AFRICA (VSO-RAISA)
2004

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This is the report of an annual conference entitled 'Tomorrow’s future, today’s choices. Orphans and Vulnerable Children: Taking action, building support'. The conference included youth delegates from Malawi and Zambia and over three days focused on: care and support; rights, psychosocial support, education and networking; skills building

Disability and social responses in some Southern African nations : Angola, Botswana, Burundi, D.R. Congo (ex Zaire), Malawi, Mozambique, Namibia, Tanzania, Rwanda, Zambia, Zimbabwe. A bibliography, with introduction and some historical items

MILES, M
January 2003

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(From introducton) This bibliography, currently with approx. 1400 items, began in 1996 with a focus on the development of non-medical services concerned with mental retardation (mental handicap, learning difficulties, intellectual impairment) in Zambia. The development of services for people with other disabilities, and for children, and childrearing and language use, and then developments in neighbouring countries, soon began to be added. Then the weight of the new material outgrew the initial focus. Some biomedical papers have been added for their social contents or where a community-based or health education program concerned with biomedical conditions seems relevant to the development of disability awareness in communities. Newspaper and magazine-type articles have mostly been omitted. Available to download from the CIRRIE website

Mainstreaming HIV/AIDS : a conceptual framework and implementing principles

JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS)
Deutsche Gesellschaft für Technische Zusammenarbeit GmbH (GTZ)
et al
June 2002

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This document explores the current understanding of mainstreaming, and examples of relevant experience. It provides a set of basic principles designed to enable those working at the different levels and aspects of HIV/AIDS policy and practice to begin using mainstreaming processes to expand and accelerate responses to HIV/AIDS

Mainstreaming HIV/AIDS : looking beyond awareness

WILKINS, Marissa
VASANI, Dolar
2002

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The social and environmental circumstances that lead vulnerable people to have unprotected sex, exposing them to infections, have to be resolved through addressing the causes of poverty, gender discrimination, and the use of sex as a commodity. This book addresses the impact of HIV without prejudice, by taking a human rights stance. It is useful for trainers, programme planners, policy-makers and CBR programmes

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