No abstract

Climate change presents a major threat to water and sanitation services. There is an urgent need to understand and improve resilience, particularly in rural communities and small towns in low- and middle-income countries that already struggle to provide universal access to services and face increasing threats from climate change. To date, there is a lack of a simple framework to assess the resilience of water and sanitation services which hinders the development of strategies to improve services. An interdisciplinary team of engineers and environmental and social scientists were brought together to investigate the development of a resilience measurement framework for use in low- and middle-income countries. Six domains of interest were identified based on a literature review, expert opinion, and limited field assessments in two countries. A scoring system using a Likert scale is proposed to assess the resilience of services and allow analysis at local and national levels to support improvements in individual supplies, identifying systematic faults, and support prioritisation for action. This is a simple, multi-dimensional framework for assessing the resilience of rural and small-town water and sanitation services in LMICs. The framework is being further tested in Nepal and Ethiopia and future results will be reported on its application.

This article makes a case for a reconceptualisation of aid and development programme design. Specifically, it questions the role of the international "development expert" in the design and implementation process. We argue that by employing "design thinking" as a guiding principle, the way in which aid programmes are envisaged and delivered can be radically overhauled, resulting in dramatically improved outcomes for the users of aid. We argue that practical improvements in delivery are achievable through locally rooted, "user-driven" development solutions that originate from the beneficiaries themselves. Design thinking as applied here goes significantly further than other programme design and implementation methodologies that champion locally owned, needs-driven assistance. Furthermore, we make a case for this approach addressing wider problems within the sector, namely the perception, in some quarters, that aid is intrinsically "neo-imperialist" in design and ideologically driven.

Traditional healing remains an important aspect of many people’s engagement with healthcare and, in this, responses to the treatment of HIV/AIDS are no different. However, given the gravity of the global HIV/AIDS pandemic, there has been much debate as to the value of traditional healing in this respect. Accordingly, this paper explores the extent to which meaningful accommodation between the biomedical and traditional sectors is possible (and/or even desirable). It does this through a consideration of Native American and South African experiences, looking at how the respective groups, in which medical pluralism is common, have addressed the issue of HIV/AIDS. The paper points to the importance of developing “culturally appropriate” forms of treatment that emphasise complementary rather than adversarial engagement between the traditional and biomedical systems and how policymakers can best facilitate this.

This article analyses, from a policymaking perspective, the continued recourse to South Africa's thriving traditional healthcare sector, which operates in tandem with the country's relatively well-developed biomedical healthcare sector. It considers the traditional healthcare sector's potential to impact on orthodox approaches to the treatment and management of HIV/AIDS, including the uptake of antiretroviral therapy. It highlights the urgent necessity of more thorough engagement between the traditional and biomedical sectors, particularly where supernatural elements -an integral part of much traditional diagnosis and treatment -are concerned. The challenge for policymakers is how best to facilitate an effective means of meaningfully accommodating potentially conflicting traditional cosmologies within the formal healthcare infrastructure. However, although the achievement of this would represent a vital step towards a more effective overall approach to South Africa's HIV/AIDS pandemic, this article queries whether it is indeed feasible.