Background: Women often use natural resources differently than men yet frequently have minimal influence on how local resources are managed. An emerging hypothesis is that empowering more women in local resource decision-making may lead to better resource governance and conservation. Here we focus on the forestry and fisheries sectors to answer the question: What is the evidence that the gender composition of forest and fisheries management groups affects resource governance and conservation outcomes? We present a systematic map detailing the geographic and thematic extent of the evidence base and assessing the quality of the evidence, as per a published a priori protocol. Methods:We screened 11,000+ English-language records in Scopus, CAB abstracts, AGRIS, AGRICOLA, Google Scholar, and Google. The websites of 24 international conservation and development organisations, references of included articles, and relevant systematic reviews were also searched for possible documents. A number of groups and individuals were invited to submit documents through email 'call outs' . The inclusion criteria were that an article refers to women or gender, forests or fisheries, and a resource management group comparison in a non-OECD country plus Mexico and Chile.Results: Seventeen studies met the inclusion criteria. Four were qualitative and 13 were quantitative. Forest studies outnumbered fisheries studies 14-3. The majority of the studies came from India and Nepal and focused on forest management. All 17 studies identified improvements in local natural resource governance, and three identified conservation improvements when women participated in the management of the resources. Only two studies, however, were rated as high quality based on study design. Conclusions: For India and Nepal, there is strong and clear evidence of the importance of including women in forest management groups for better resource governance and conservation outcomes. Outside of India and Nepal, there are substantial gaps in the evidence base, but the South Asian evidence presents a compelling case for extending the research to other geographies to see if similar outcomes exist elsewhere and supports a theory of change linking the participation of women in forestry and fisheries management groups with better resource governance and conservation outcomes.
Background Access to prompt and appropriate treatment is key to survival for children with malaria, pneumonia and diarrhoea. Community-based services are vital to extending care to remote populations. Malaria Consortium supported Niger state Ministry of Health, Nigeria, to introduce and implement an integrated community case management (iCCM) programme for four years in six local government areas (LGAs). The objective was to increase coverage of effective treatment for malaria, pneumonia and diarrhoea among children aged 2-59 months. Methods The programme involved training, equipping, ongoing support and supervision of 1320 community volunteers (CORPs) to provide iCCM services to their communities in all six LGAs. Demand creation activities were also conducted; these included community dialogues, household mobilization, sensitization and mass media campaigns targeted at programme communities. To assess the level of changes in care seeking and treatment, baseline and endline household surveys were conducted in 2014 and 2017 respectively. For both surveys, a 30×30 multi-stage cluster sampling method was used, the sampling frame being RAcE programme communities. Results Care-seeking from an appropriate provider increased overall and for each iCCM illness from 78% to 94% for children presenting with fever ( P < 0.01), from 72% to 91% for diarrhoea cases ( P < 0.01), and from 76% to 89% for cases of cough with difficult or fast breathing ( P < 0.05). For diagnosis and treatment, the coverage of fevers tested for malaria increased from 34% to 77% ( P < 0.001) and ACT treatments from 57% to 73% (<0.005); 56% of cases of cough or fast breathing who sought care from a CORP, had their respiratory rate counted and 61% with cough or fast breathing received amoxicillin. At endline caregivers sought care from CORPs in their communities for most cases of childhood illnesses (84%) compared to other providers at hospitals (1%) or health centres (9%).This aligns with caregivers’ belief that CORPs are trusted providers (94%) who provide quality services (96%). Conclusion Implementation of iCCM with focused demand creation activities can improve access to quality lifesaving interventions from frontline community providers in Nigeria. This can contribute towards achieving SDGs if iCCM is scaled up to hard-to-reach areas of all states in the country.
Background In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses – malaria, pneumonia, and diarrhea – while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.
NGO projects implementing community-based intervention packages appear to be effective in reducing child mortality in diverse settings. There is plausible evidence that they raised coverage for a variety of high-impact interventions and improved U5MR by more than twice the concurrent secular trend. All projects used community-based strategies that achieved frequent interpersonal contact for health behaviour change. Further study of the effectiveness and scalability of similar packages should be part of the effort to accelerate progress towards MDG 4.
BackgroundLay support has been associated with improved breastfeeding practices, but studies of programs that engage men in breastfeeding support have shown mixed results and most are from high-income countries. The purpose of our research is to review strategies to engage men in exclusive breastfeeding (EBF) promotion or support in 28 project areas across 20 low- and middle-income countries. This information may be used to inform program implementers and policymakers seeking to increase EBF.MethodsWe tested the difference between baseline and final EBF proportions using Pearson’s chi-square (a = 0.05) and identified project areas with a significant increase. We categorized male engagement strategies as low- and high-intensity, using information from project reports. We looked for patterns by intensity and geography and described strategies used to engage men in different places.ResultsTwenty-eight projects were reviewed; 21 (75%) were in areas where a statistically significant increase in EBF was observed between the beginning and end of the project. A variety of high- and low-intensity male engagement strategies was used in areas with an increase in EBF prevalence and in all geographic regions. High-intensity strategies engaged men directly during home or health visits by forming men’s groups and by working with male community leaders or members to promote EBF. Low-intensity strategies included large community meetings that included men, and radio messages, and other behavior change materials directed towards men.ConclusionMale engagement strategies took many forms in these project areas. We did not find consistent associations between the intensities or types of male engagement strategies and increases in EBF proportions. There is a gap in understanding how gender norms might impact male involvement in women’s health behaviors. This review does not support the broad application of male engagement to improve EBF practices, and we recommend considering local gender norms when designing programs to support women to EBF.
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