54 The report of people living with HIV/AIDS (PLWHA) in Jember district since 2004 until 2014 always increase every year. According to reports from Jember District Health Office ( 2015 ), until August 2015, cases of PLHA has reached 2,048 . It represents the third highest case in East Java after Surabaya and Malang . Referring to the high incidence of HIV/AIDS in Jember , the prevention and control of HIV/AIDS should have a strong legal policy. Thus the policy of the Regent of Jember Number 2 in 2014 on the Prevention and Control of HIV / AIDS in Jember was very strategic in engaging all elements in the government (SKPD) related as well as on the participation of the entire community as well as at the level of district, and rural and urban districts. This study aimed to analyze the policy of the Regent of Jember Number 2 in 2014 on the Prevention and Control of HI V/AIDS in Jember . This research is descriptive analytic with logical thinking approach to policy analysis , using the theory of Triangle Policy Analysis by Buse et al (2005 ) which includes : conteks , content , process and actors . Research was conducted on January until March 2016. The data obtained will be analyzed and linked to theories and concepts within the scope of health policy. The results showed that in terms of conteks included in situational factors or 'focusing event' is the discovery of HIV / AIDS cases in Jember very high that it becomes one of 78 District/City which received special attention from the NAC. While structural factors, namely the issuance of the East Java Provincial Regulation Number 5 in 2004 on the Prevention and Control of HIV/AIDS in East Java and Jember Regent Regulation which Number 45 on the Main Tasks and Functions Organization Jember district health office. In terms of content mentions that the contents of the policy consists of Chapter I. General Provisions, Chapter 2. Goals, Chapter III. Prevention and Control, Chapter IV. Rights of PLHA, Chapter V. Prohibition, Chapter VI. Institutional and Chapter VII. Closing. In terms of process, the enactment of the East Java Provincial Number 5 in 2004 on the Prevention and Control of HIV / AIDS in East Java, and the The policy of the regent of Jember which number 45 on the Main Tasks and Functions Organization of the Health Department of Jember. The policy of the prevention of HIV/AIDS was not separated from only the advocacy of Department of Health and KPAD of Jember Regency against the local authorities as well as support from the relevant agencies. From the actor, in the personal of the HIV and AIDS PreventionTeam was from the district, sub-district, and villages. That policy of Jember Regent in the regulation which Number 2 in 2014 on the Prevention and Control of HIV / AIDS in Jember Regency was very effective in providing a strong legal policy on a program of prevention and control of HIV and AIDS in Jember.
Military personnel are among the core groups most at risk to HIV acquisition and transmission because of their occupation and lifestyle. Available data shows that voluntary counseling and testing for HIV uptake was low in the members of Ethiopian army. It is known that VCT for HIV is crucial strategy for HIV prevention. Therefore, identifying rate of VCT and factors correlated with low uptake in the army could intensify the national responses to the HIV pandemic. A cross-sectional survey was conducted on randomly selected 917 male army members of randomly selected Division of Northern command, deployed in Eastern Tigray about 900km north to Addis Ababa in October 2006. After data was collected, using pre-tested structured and standard questionnaire, cleaned, entered and analyzed using SPSS. Odds ratio with 95 % confidence interval was used to test statistical significance and degree of association. The median age of respondents was 28(±5.6), with age range from 18-47 years. The majority of participants 567(61.8%) were between 18–29 years of age. Almost 99% of the participants were literate, and 441(48.1%) were ever married and the median age at first marriage was 25 years. The data showed that 430(46.9%) of all participants were tested for HIV of which 421 were through VCT. The data also revealed that VCT utilization rate in the study subjects was 45.9%. The most common reason for VCT was 'to know self', 86.2%. All participants who had VCT were satisfied with the service given. Among 487 HIV non-tested participants the reasons given for non-uptake of VCT were no near by service 38.8%, afraid to get test result 33.9%, fear of stigma 17.7%, and partner and/or self-trust 13.8%. 9 Using multiple logistic regression analysis, controlling for various demographic characteristics, as well as behavioral, cognitive, social, and VCT service related factors; it was found that soldiers with the following characteristics were most likely to have undergone VCT. Those who discussed HIV/AIDS with in the family, those who ever had sexual contact, those who knew a person infected with HIV or died of AIDS, those who were knowledgeable about the uses of VCT, and those who had non-stigmatizing attitude towards PLWHA. On the other hand it was found that soldiers with the following characteristics were less likely to have undergone VCT: those who were currently not married but living with sexual partner, those who had uncertainty about their HIV status, and those who preferred integrated VCT clinics located in the civilian health institution. This study shown that rate of VCT utilization in the army is increasing and many variables shown correlation with VCT-uptake. Therefore, we recommend that interventions be aimed at those variables suggesting causation and to scale up VCT services. Furthermore, we recommend that qualitative research be conducted to identify which of these correlations have a causal relationship to VCT-uptake
Executive summary Introduction CTA works primarily through intermediary organisations and partners (non-governmental organisations, farmers' organisations, regional organisations) to promote agriculture and rural development and to deliver its various information products and capacity building services. By partnering with these organisations, CTA seeks to increase the number of ACP organisations capable of generating and managing information and developing their own information and communication management strategies. In the period 2003 – 2005, CTA undertook a series of needs assessment studies in 21 countries in the ACP Pacific and Caribbean. As a continuation of this process, CTA have now commissioned assessments of the agricultural information needs of 6 countries emerging from prolonged conflict situations in ACP Africa, including Mozambique, which forms the focus of this report. Objectives of the Study The objectives of this study are to develop a strategy for CTA's approach to post-conflict countries, to improve the effectiveness of CTA's support for post-conflict countries and to compile baseline data on the status of ICM and ICTs in agriculture and rural development in Mozambique. Methodology The country profile was produced through a desk study. This study relied heavily on information available on the internet and additional information was obtained from various institutions in Mozambique, internationally and from key informants. Through the desk study we were able to identify a list of nine key institutions. This list was discussed with CTA and informants in Mozambique and face to face interviews were requested with each institution. Of these, seven of the institutions agreed, whilst one indicated that it would be closing its operations within a year and was therefore removed from the list. Expected results This study will provide: 1) an inventory of the status of agricultural information services, institutions and other actors and their needs as their relate to physical infrastructure, information availability and access and human capacity development; 2) an assessment of the current and / or planned interventions of the government and bi- or multilateral agencies in the field of information for agriculture and rural development; 3) an overview of the needs of potential partners for CTA activities and services in terms of building capacity for information and communication management; 4) a short-list of potential partners / beneficiaries for CTA activities and services; 5) baseline data to facilitate subsequent monitoring activities. The study will also provide a framework for CTA to develop a framework for action and fashion a strategy aimed at institutions in countries emerging from conflict situations and provide input into its 2006 – 2010 strategic plan. Findings Following the signing of a peace agreement in 1992 to end 16 years of conflict, Mozambique has achieved impressive economic growth and lowered its prevalence of poverty. Sustained by strong foreign investment, real GDP in Mozambique has been growing at rates in excess of 7 percent for the last 4 consecutive years, and per capita income in US dollars has increased by nearly 50 percent between 2001 and 2004. Mozambique's economic growth, however, implies an important transformation in the composition of its GDP, although services remain the dominant sector. The share of industry in total GDP increased to 27 percent in 2004 from about 16 percent in 1996, whereas the share of agriculture decreased to 23 percent from about 30 percent in the same period. The agricultural sector, however, still supports 80 percent of the economically active population, and agriculture still provides major export earnings from commodities such as prawns and fish, cotton, sugar, timber and cashew nuts. The forestry sector also has an important role in the country, contributing 4 percent of gross domestic product and supplying about 80 percent of the energy used. There is no unified policy or strategy in Mozambique with regard to the management of agricultural information and broad dissemination networks are not well developed. Institutions that fall outside of the state or donor worlds often find it difficult to get hold of information. Information exchange between institutions tends to be informal rather than structured. Agricultural research generally is restricted by the insufficient number of scientists who can formulate and carry out studies relevant to Mozambican needs. Budgets for information management tend to be a low priority. In-house capacity for maintaining and troubleshooting computer networks is a constraint; reliance is made upon private companies specialised in IT. Retention of staff at the centre with IT skills, in the face of competition from the private sector, was cited as a problem by all of the state agencies. Building the capacities of in-house staff was therefore felt to be important. Existing websites, maintained by some of the key institutions vary in their effectiveness as publishing outlets and often tend to be reflections of the institution, its structure and its work programme, rather than being designed specifically to disseminate information, reports, studies, etc. that are produced, or to act as advocacy tools. Use of radio as a means of disseminating information in vernacular languages is still rather limited. Problems in this respect are the costs of translation and payments for the transmissions. Training in how to pass information on to low literacy groups was also indicated by several agencies. This included training in more effective writing skills and training in how to compile radio programmes and audio visual materials. There is a general lack of metadata; documentation on who is doing what and types of available information is generally poor. This has a double negative effect. On one hand, potential data and information users have difficulties finding or getting access to relevant information and on the other hand, information suppliers do not know what they have, which prevents better organisation of information for dissemination. Conclusions Most of the institutions which we interviewed have fairly well-developed links to relevant sources of information; data on the functioning of markets, prices and production levels in the agriculture and fisheries sectors has vastly improved in recent years. Some of these agencies need information on regional and international markets and production levels. Technical data is still harder to source, particularly in Portuguese. There are information needs regarding developments in thinking on food security, forms and means of supporting organisations at community level, participatory approaches to resource management, information on low cost technologies for increasing production and conserving produce, on gender, on HIV/AIDS prevention and mitigation strategies and on general rural development issues. Respondents requested capacity building in information management to increase the effectiveness of their organisations. Government services and NGO staff indicated the importance of training in the analysis of socio-economic data. Training in the use of the internet to obtain information and in the targeting of information by library and documentation services was also a broad need. The design and development of web sites was indicated by many respondents, but it is felt that there is a particular need for support in how to conceptualise these as sources of information rather than just 'publicity'. Training in effective communication to low literacy target audiences, in the development of extension materials and the use of radio and audio-visual materials is also important. Recommendations We recommend that CTA provide support to the development of a national IMC strategy for agricultural information that takes full advantage of the opportunities offered by the new GovNet infrastructure. The ICM strategy should ensure that information is easily available to all stakeholders in rural development. Furthermore, the ICM strategy should prevent a gap from evolving between organisations connected to GovNet and those that are not. Finally, the ICM should provide for communication channels from the rural poor to research organisations and policy makers, to ensure that research and policies are guided by the needs of poor rural households. We recommend that CTA attempts to increase the amount of information disseminated in Portuguese language, particularly in regard to food security, forms and means of supporting organisations at community level, participatory approaches to resource management, information on low cost technologies for increasing production and conserving produce, on gender, on HIV/AIDS prevention and mitigation strategies and on general rural development issues. We recommend that CTA support short term research activities targeted at Mozambican-specific issues in relation to agricultural production and the conservation of produce. Links should be set up to inform IIAM and DNER about the information needs of poor farmers, women and PLWHA. These links can be set up through members organisations such as ORAM and UNAC, through Farmer Field Schools and through NGOs to which DNER has outsourced extension activities. We recommend that CTA investigate ways of supporting exchange of experience between organisations involved in training through associations and support to the development of training packages for associations. These should be provided to increase the effectiveness and efficiency of extension efforts in the field. In the long term, the required technical information can be provided to associations through newly developed training packages. ; The objectives of this study are to develop a strategy for CTA's approach to post-conflict countries, to improve the effectiveness of CTA's support for post-conflict countries and to compile baseline data on the status of ICM and ICTs in agriculture.
More than 16 years post-apartheid, South Africa is still regarded as the most unequal society in the world. The government is facing various obstacles and challenges in improving the standard of living and quality of life for all its citizens, for example in facilitating the access to clean drinking water and sanitation, building houses and providing basic education. In addition, the country is facing the world's largest HIV/AIDS epidemic with a national prevalence rate of 18.1 %, equalling approximately 5.7 million people who are currently infected. (Pressly, 2009; UNAIDS, 2008c) Against this background, the aim of this thesis was to study the Madwaleni community, situated in a deeply rural area of the former apartheid homeland Transkei. Applying the Community Oriented Primary Care approach, a strategy of 'community assessment and diagnosis' was used to obtain a holistic community profile and to determine the perceptions of its community members regarding their health and social problems and needs, intending to make recommendations to health care providers working at Madwaleni Hospital regarding future health education and disease prevention programmes. (Brown and Fee, 2002) This research used a cross-sectional design. In a preliminary survey, qualitative data was collected in short interviews with health care providers working at Madwaleni Hospital (N=46). The information served as a basis to develop and design parts of the Madwaleni community survey questionnaire. The questionnaire consisted of 36 questions, complying with the aim and objectives of this thesis. It was used for the structured interviews with the main study population, all of whom were members of the Madwaleni community (N=200), whereas half of the main study population were men and half were women, then again, half were unaware of their HIV status and half were HIV+ and had joined the Madwaleni HIV/AIDS programme. Key findings 1) Madwaleni community profile and characteristics Thoughtful sexual behaviour: Particularly interesting in light of the HIV/AIDS epidemic, more than 90 % of the sexually active community members were monogamous at the time of the survey. While only 36.4 % of the men and women unaware of their HIV status used condoms, 76.5 % of the HIV+ community members claimed to do so, indicating that the Madwaleni HIV wellness programme and especially its counselling and health education components are adequate and valuable in serving their purpose. High rates of illiteracy and insufficient education: Only 56.5 % of the interviewed community members were 'functionally literate' at the time of the survey. Of those, only 8 % had received a matriculation and not one of the community members had received any higher degree. In addition, 19.5 % of the sampled men and women were not able to read at all. High rates of unemployment, poverty and dependency on welfare grants: Only 20 % of the Madwaleni community members were employed at the time of the survey. Taking the daily income per capita as a reference, one third of the community members suffered from 'moderate poverty', defined as an income of 1 to 2 US $ per day, while the other two thirds suffered from 'extreme poverty', defined as an income of less than 1 US $ per day, although more than 90 % of the corresponding households received at least one type of welfare grant already. Large household sizes and predominance of traditional dwellings: In the Madwaleni community, an average of eight people lived together per household at the time of the survey, whereas 95 % of the community members lived in traditional dwellings, constructed from freely occurring natural resources. In need of safe drinking water, sanitary systems and access to electricity: More than 80 % of the Madwaleni community members obtained their drinking water from rivers or stagnant dams, while only 6.5 % used rain water and 9.5 % had access to piped water. In addition, almost 70 % of the community members had no access to any sanitary systems, using nearby bushes instead. Furthermore, more than 90 % had no access to electricity. The majority used paraffin for cooking, candles for lighting and wood for heating their homes. Small-scale cultivation to provide an extra source of food: In the Madwaleni area, 90 % of the families owned a small garden patch attached to their houses, used for small-scale cultivation. In addition, almost 90 % owned livestock, mainly poultry, cattle and goats. Crops and animals were used to provide an extra source of food; however, not one of the households could solely live on subsistence farming. Difficulties in accessing health care facilities: On average, each of the community members needed three-quarters of an hour to access their closest clinic and almost one and a half hours to reach Madwaleni Hospital, with 40 % and 60 % respectively depending on public taxi transport to get there. No substantial improvement of the living circumstances since apartheid: Comparing the Madwaleni community characteristics with corresponding data from apartheid-times, no substantial improvement of the living circumstances and conditions could be noticed, proving that governmental and non-governmental actions, programmes and services have not yet reached all remote communities. Similar community characteristics in the neighbouring communities: Comparing these characteristics with corresponding features of communities in the immediate or surrounding areas, namely Cwebe, Ntubeni, Mboya, Shixini and Zithulele, various similarities could be detected, indicating that the living circumstances and conditions might be generalisable to a certain degree, at least to deeply rural communities in the former Transkei area. More disadvantaged than the general South African population: The Madwaleni community differed significantly from the general South African population in 75 % of the compared characteristics. For example, amongst the community members the illiteracy rate (21.7 % vs. 13.6 %, p = 0.002) and unemployment rate (80.5 % vs. 25.5 %, p < 0.001) were significantly higher. In addition, the 'poverty headcount ratio of 2 US $ per day' showed that significantly more people were suffering from poverty in the Madwaleni area (92.2 % vs. 34 %, p < 0.001). The Madwaleni community members were less likely to have access to clean drinking water, along with significantly higher proportions of them using river water as their main source of drinking water (75.5 % vs. 5.1 %, p < 0.001). Also, they were less likely to have access to any sanitation or toilet facilities (31.3 % vs. 91.8 %, p < 0.001) or to electricity (8.5 % vs. 80.2 %, p < 0.001). 2) Weightiest health and social problems as experienced by the Madwaleni community In the Madwaleni area, the three health problems with the highest impact on the community were TB, HIV/AIDS and hypertension. On the basis of the applied 3-to-0-point rating matrix, they were rated by more than 95 % of the community members as being relevant problems, with mean values of 2.33, 2.30 and 2.14 respectively. Interestingly, women rated HIV/AIDS higher than men. Musculoskeletal problems and headache were additional health problems with relevant impact on the Madwaleni community, rated by more than 90 %, with mean values above 1.80. While pain and discomfort experienced by PLWHA have been recognised and researched before, there are no corresponding studies on rural communities and further research is necessary to identify the contributing factors. Additional relevant health problems: Interestingly, six health problems were rated higher by HIV untested than by HIV+ community members, namely bilharzia/ schistosomiasis, epilepsy, Herpes Zoster, HIV/AIDS, lung infections and stroke. Since the HIV+ men and women were educated about and screened for all of those diseases within the Madwaleni HIV/AIDS programme, this might explain the deviating rating patterns between the different sub-samples. Moreover, these results demonstrate that health education and disease prevention programmes are able to reduce the perceived burden of health problems and might therefore serve as a substantial argument in their favour. Interestingly, for the Madwaleni community, social matters had a higher impact on their lives than health problems, whereas the three social problems with the highest impact on the community were alcohol abuse, dependency on social grants and smoking. They were rated by more than 98 % of the community members as being relevant problems, with mean values of 2.75, 2.73 and 2.72 respectively. In accordance with these findings, employment & lack of work opportunities, education & illiteracy, food supply and poverty were additional social problems with relevant impact in the Madwaleni area, rated by more than 90 %, with mean values above 2.00. 3) Recommendations for future health education and disease prevention programmes At the time of the survey, the three most relevant health education and disease prevention topics for the Madwaleni community were HIV/AIDS, TB and healthy nutrition. They were rated by more than 95 % of the community members as being relevant health education problems, with mean values of 2.65, 2.51 and 2.36 respectively. In addition, STIs, alcohol & drug-related problems, water & sanitation and body & muscle pain were rated as the subsequent issues of relevance, with mean values above 2.00, supporting the identified community characteristics as well as the listing of the weightiest health and social problems. In addition, valuable new insight could be gained. For instance, HIV untested men rated the topic HIV/AIDS lower than all other community members, which is particularly interesting since men only constitute a minority of 20 % of the people testing for HIV in the Madwaleni area. Besides, topics not previously considered, such as injury prevention and basic first aid, were in-fact relevant for more than 85 % of the community members and require further attention. Furthermore, deviating rating patterns between men and women and the corresponding need for gender-specific educational workshops became evident, for example, for men about prostate & testicular cancer check-up or erectile dysfunction and for women about breast & cervical cancer check-up & papsmears or nutrition & growth. In addition, HIV+ community members rated depression & stress and psychiatric diseases higher than HIV untested men and women, with further studies required to identify the underlying reasons for these deviating rating patterns. Taking all findings from this Madwaleni community survey into consideration, health care providers working at the hospital and its peripheral clinics should first and foremost concentrate their efforts on maintaining the existing programmes, particularly, the Madwaleni HIV/ARV programme and the workshops on hypertension and diabetes mellitus. In addition, if qualified and motivated personnel can be recruited and the necessary funding can be raised, future health education and disease prevention programmes should focus on TB, alcohol & substance abuse-related problems as well as water & sanitation.
