Adolescents' views of and preferences for sexual and reproductive health services highlight promising directions and persistent challenges in preventing pregnancy and HIV and treating sexually-transmitted infections (STIs) in this population. Results from nationally-representative surveys of 12-19 yearolds in Burkina Faso, Ghana, Malawi and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually-active adolescents do not know of any source to obtain contraception or get STI treatment, and social-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility and cost. Some gender and country differences exist, yet overall females and males' views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities and improve youth's access to them, especially by reducing social barriers. Une grande proportion des adolescents qui sont sexuellement actifs ne connaissent pas les sources pour obtenir la contraception ou le traitement pour les IST; ensuite, des raisons socio-psychologiques (l'embarras et la peur) et le coût financier demeurent des obstacles à l'obtention des services. Les préférences des adolescents sont largement pour des cliniques publiques avec leur fortes perceptions positives de la confidentialité, de l'accessibilité et du coût. Il existe aussi certaines différences au niveau des genres et des pays, pourtant, en général, les opinions des mâles et des femelles sont similaires. Les résultats mettent l'accent sur la nécessité de renseigner la jeunesse sur les sources, d'augmenter la disponibilité des établissements de santé et d'améliorer l'accès de la jeunesse à ces établissements, surtout par la réduction des obstacles sociaux. (Rev Afr Santé Reprod 2007; 11[3]:99-110).

There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

Africa’s recent communications ‘revolution’ has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to ‘care’ even at substantial personal cost. Although there is significant potential for ‘informal mhealth’ to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.

Young people's use of mobile phones is expanding exponentially across Africa. Its transformative potential is exciting, but findings presented in this paper indicate how the downside of mobile phone use in African schools is becoming increasingly apparent. Drawing on mixed-methods field research in 24 sites across Ghana, Malawi and South Africa and associated discussions with educational institutions, public policy makers and network providers, we examine the current state of play and offer suggestions towards a more satisfactory alignment of practice and policy which promotes the more positive aspects of phone use in educational contexts and militates against more damaging ones.

The African communications 'revolution' has generated optimism that mobile phones might help overcome infrastructural barriers to healthcare provision in resource-poor contexts. However, while formal m-health programmes remain limited in coverage and scope, young people are using mobile phones creatively and strategically in an attempt to secure effective healthcare. Drawing on qualitative and quantitative data collected in 2012-2014 from over 4500 young people (aged 8-25 y) in Ghana, Malawi and South Africa, this paper documents these practices and the new therapeutic opportunities they create, alongside the constraints, contingencies and risks. We argue that young people are endeavouring to lay claim to a digitally-mediated form of therapeutic citizenship, but that a lack of appropriate resources, social networks and skills ('digital capital'), combined with ongoing shortcomings in healthcare delivery, can compromise their ability to do this effectively. The paper concludes by offering tentative suggestions for remedying this situation.

In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one’s partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.

(2012) 'Youth, mobility and mobile phones in Africa : ndings from a three-country study.', Information technology for development., 18 (2). pp. 145-162. Further information on publisher's website: Additional information:Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.

Living conditions and poverty are two common quantifiers or parameters of socioeconomic status and both have evolved from rather narrow economic and material concepts to encompass broader and more complex understandings.According to Heiberg and Øvensen (1993), studies on living conditions have evolved to include individuals' capabilities and how they utilise their capabilities. Likewise, the concept of poverty has expanded beyond a derived level of income or accumulation of material goods whereby 'poverty is now seen as the inability to achieve certain standards', poor people 'often lack adequate food, shelter, education, and health care', and 'they are poorly served by institutions of the state and society' (Wolfensohn and Bourguignon, 2004, p 4). The two concepts are not interchangeable, however; they stem from different research traditions and differ in use both for research and for practical purposes. While poverty research has focused on defining poverty and establishing poverty profiles, identifying poor populations and strategies for reducing poverty, studies on living conditions are based on more loosely bound sets of indicators that are applied to measure, for example, level of income, education, access to information, access to healthcare and social participation in a population, and to establish differences between population sub-groups for descriptive, comparative and monitoring purposes. Poverty is both a more general and complex phenomenon than living conditions, and the field of poverty research has recently been characterised as 'polyscopic', indicating that we are dealing with a multifaceted umbrella term and a conglomerate of perspectives and methods (Øyen, 2005). Surveys of living conditions in a population can, however, provide indicators on poverty and disability, and, if properly designed, they can be applied to study poverty mechanisms, poverty development and trends in a population, as well as contributing to decisions that may be applied to poverty alleviation. In this chapter data collected on the living conditions among people with and without disabilities in the southern African region will be utilised to assess the disability-poverty relationship.