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BackgroundInternational donors support the partnership between the Government of Botswana and two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. Botswana Government had started integration of the program into its health system when international partners brought in the Models for Optimizing Volume and Efficiency to strengthen delivery of the service and push the target. The objective of this paper is to use a systems model to establish how the functioning of the partnership on Safe Male Circumcision in Botswana contributed to the outcome.MethodsData were collected using observations, focus group discussions and interviews. Thirty participants representing all three partners were observed in a 3-day meeting; followed by three rounds of in-depth interviews with five selected leading officers over 2 years and three focus group discussions.ResultsFinancial resources, “ownership” and the target influence the success or failure of partnerships. A combination of inputs by partners brought progress towards achieving set program goals. Although there were tensions between partners, they were working together in strategising to address some challenges of the partnership and implementation. Pressure to meet the expectations of the international donors caused tension and challenges between the in-country partners to the extent of Development Partners retreating and not pursuing the mission further.ConclusionTarget achievement, the link between financial contribution and ownership expectations caused antagonistic outcome. The paper contributes enlightenment that the functioning of the visible in-country partnership is significantly influenced by the less visible global context such as the target setters and donors.

Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

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Refugees from the Global South face many challenges when they arrive in Europe, not least having their subjectivities and beliefs questioned as part of requests for them to adapt to the norms of the destination context. Although there has been much critical research on migrant integration and adaptation, few of these studies have used an intergenerational lens to investigate the experiences of refugee children and youth. This article addresses this research gap using a social navigation theoretical framework and qualitative data obtained from focus group discussions with Eritrean and Afghan unaccompanied minors, young adults, and parents. The findings demonstrate how challenges and resources associated with adaptation identified across generations were related to (a) the frequency and nature of interactions between refugees, their compatriots, and Norwegians; (b) learning the Norwegian language; (c) comprehension of Norway's bureaucratic welfare systems; and (d) accepting Norwegian cultural values while maintaining transnational cultural ties. Notably, unaccompanied minors, young adults, and parents all navigated dual cultures as part of efforts to achieve normative Norwegian markers of successful migrant adaptation. Significantly, the older generational groups had the most difficulty “breaking” into Norwegian society. Overall, it is argued that to understand better the challenges migrants face when they are required to adapt to a new life in a destination context and the implications of these challenges for their aspirations, it is important to include both a focus on how they move through the society (social navigation) and the interactivity between generations (intergenerational perspective).

BackgroundPartnerships in global health and development governance have been firmly established as a tool to achieve effective outcomes. Botswana implements Safe Male Circumcision (SMC) for HIV prevention through a North-South partnership comprising the local Ministry of Health, US Centers for Disease Control and Prevention (funded by PEPFAR) and Africa Comprehensive HIV/AIDS Partnership (funded by the Bill and Melinda Gates Foundation). The SMC partnership experienced significant antagony and the aim of this paper is to illuminate the actions and processes in the SMC program that contributed to that antagony.MethodsMethods used to gather data include observation of the partners’ planning and strategic meeting in 2012, in-depth interviews with lead officers at national level, focus group discussions with district officers and implementers, younger male officers and old community members as recipients of the service.ResultsThe findings reveal that the partnership experienced antagony during operational processes and as the ultimate outcome. Target setting, financial power of the North, superficial ownership given to the South, ignoring local traditional realities results in antagony. Three roots of antagony have been identified: 1. therapeutic domination–medical expertise given with arrogance; 2.iatrogenic violence–good intentions that cause unintended harm; 3. the Trojan horse–Reckless acceptance of the gift as well as deceptive power positioned under the pretext of benevolence.ConclusionThe three roots of antagony; therapeutic domination, iatrogenic violence and the Trojan horse, constitute attitudes, hidden intentions and unintended consequences that influence program implementation and cause harm at different levels. Examples of therapeutic domination and the Trojan horse have highlighted the need for vigilance at the stage of establishing a partnership, to prevent more powerful partners from developing and applying hidden agendas and to strengthen accountability from the local partner. Iatrogenic violence has highlighted the need for partnership interventions to prevent good partner intentions accidentally producing bad outcomes.

Drawing can improve sensory motor skills, encourage the use of imagination, help to develop creativity, and above all presents a fun and enjoyable pastime (Vendeville et al. 2018). However, beyond play and skill development, it is an important method of communication and a tool for exploring complex and difficult issues, which may be more challenging with younger individuals (Pifalo 2007;Ugurlu et al. 2016). Drawing can also assist as a therapeutic aid in the identification of pathways to good health and well-being, such as enabling young people to map and reflect on their local supportive resources, in turn enabling a more positive reappraisal of their situation (Campbell et al. 2010;Campbell et al. 2015). The first chapter of this volume (see Chap. 1), describes the potential for the Arts and health promotion in a broad treatment, this chapter focuses specifically on the salutogenic qualities of drawing.