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We analyze the costs and benefits of "Community-Led Total Sanitation" (CLTS), a sanitation intervention that relies on community-level behavioral change, in a hypothetical rural region in Sub-Saharan Africa with 200 villages and 100,000 people. The analysis incorporates data on the effectiveness of CLTS from recent randomized control trials (RCTs) and other evaluations. We value reduced mortality benefits by adjusting estimates for the value of statistical life (VSL) from high income countries to reflect incomes in Sub-Saharan Africa. Reduced morbidity benefits are calculated using a cost of illness (COI) approach based on recent studies quantifying the cost of diarrheal disease in Sub-Saharan Africa. Time savings from owning a latrine are valued using estimates for the shadow value of time based on a proportion of the average local wage. Costs include the cost of intervention implementation and management, households' time costs for participating in the community behavioral change activities, and the cost of constructing latrines. We estimate the net benefits of this intervention both with and without the inclusion of a positive health externality, which is the additional reduction in diarrhea for an individual when a sufficient proportion of other individuals in the community construct and use latrines and thereby decrease the overall load of waterborne pathogens and fecal bacteria in the environment. We examine the sensitivity of the results to changes in the effectiveness of the CLTS intervention. A probabilistic sensitivity analysis using Monte Carlo simulation is used to examine the sensitivity of the results to changes in all of the parameters in the benefit-cost model. We find that CLTS interventions would pass a benefit-cost test in many situations, but that benefit-cost metrics are not as favorable as many previous studies suggest. The model results are sensitive to baseline conditions, including the income level used to calculate the VSL, the discount rate, and the time spent traveling to defecation sites. We conclude that many communities will have economic investment opportunities that are more attractive than CLTS, and recommend careful economic analysis of CLTS in specific locations.
Global Handwashing Partnership;
In this summary, we outline key themes and findings from 117 handwashing-related research papers published in 2017. This summary presents the overarching findings of the literature on handwashing, and explores specific data and context. Key themes include access and coverage; benefits of handwashing; measuring handwashing compliance; handwashing behavior change; drivers of handwashing; and efficacy of handwashing hardware including various types of soaps and rubs.
Water quality testing is critical for guiding water safety management and ensuring public health. In many settings, however, water suppliers and surveillance agencies do not meet regulatory requirements fortesting frequencies. This study examines the conditions that promote successful water quality monitoring inAfrica, with the goal of providing evidence for strengthening regulated water quality testing programs. Methods andfindings:We compared monitoring programs among 26 regulated water suppliers and surveillanceagencies across six African countries. These institutions submitted monthly water quality testing results over 18 months. We also collected qualitative data on the conditions that influenced testing performance via approximately 821 h of semi-structured interviews and observations. Based on our qualitative data, we developed the Water Capacity Rating Diagnostic (WaterCaRD) to establish a scoring framework for evaluating the effects of thefollowing conditions on testing performance:accountability, staffing, program structure, finances, andequipment & services. We summarized the qualitative data into case studies for each of the 26 institutions and then used the case studies to score the institutions against the conditions captured in WaterCaRD. Subsequently, we appliedfuzzy-set Qualitative Comparative Analysis (fsQCA) to compare these scores against performance outcomes forwater quality testing. We defined the performance outcomes as the proportion of testing Targets Achieved (outcome 1) and Testing Consistency (outcome 2) based on the monthly number of microbial water quality tests conducted by each institution. Our analysis identified motivation & leadership, knowledge, staff retention, and transport as institutional conditions that were necessary for achieving monitoring targets. In addition, equipment, procurement, infrastructure, and enforcement contributed to the pathways that resulted in strong monitoring performance.
Agricultural Science and Technology Indicators (ASTI);
Increased use of (relatively abundant) land, rather than improved technical efficiency, has been the main driver of agricultural production growth in Africa south of the Sahara (SSA) over the past five decades. However, rapid population growth and the adverse effects of climate change are increasingly putting pressure on land availability, land fertility, and water access. Given the well-documented positive impact of agricultural research investment on agricultural productivity growth, it is critical that African countries step up their investment in agricultural research and instate sound policies to promote technological and institutional innovations in the agricultural sector.This report assesses trends in investments, human resource capacity, and outputs in agricultural research in SSA. It highlights the cross-cutting trends and challenges that emerged from ASTI's country-level data, structuring it within four broad areas: funding capacity, human resource capacity, research outputs, and institutional conditions.Key findings of the report include:Agricultural research spending in SSA grew by nearly 50 percent between 2000 and 2014. However, underinvestment remains widespread, with 33 out of 40 countries for which data were available spending less than 1.0 percent of their AgGDP on agricultural research.Across SSA, agricultural researcher numbers increased by 70 percent during 2000–2014. However, a very large share of senior PhD-qualified researchers are approaching retirement. Without adequate succession strategies and training, significant knowledge gaps will emerge.Female scientists remain grossly underrepresented in agricultural research, despite the fact that they are in a unique position to effectively address the pressing challenges facing African farmers, the majority of whom are female.Donor dependency and funding volatility remain critical in a large number of African countries.Outdated research facilities and equipment are impeding the conduct of productive research, which compromises the number and quality of research outputs and ultimately translates into reduced impact.The report concludes by outlining a number of policy measures that SSA governments can undertake to address the various challenges related to agricultural research funding, human capacity, outputs, infrastructure, and institutional structure.
Population Services International;
This literature review assesses the extent of sexual relations between adolescent girls and older male partners (cross-generational sex) in sub-Saharan Africa; the extent of transactional sex; and the behavioral dynamics of girls and men involved in these sexual relations. The underlying assumption, supported by emerging empirical study, is that sex with older men increases the girls' risk of becoming infected with HIV. Because there seems to be little programmatic attention to reducing HIV risk by focusing on these partnerships, the intention of this review is to inform the efforts of AIDSMark -- in particular, Population Services International and the International Center for Research on Women -- on how to reduce HIV risk by addressing sexual relationships between adolescent girls and older men. Over 45 quantitative and qualitative studies of crossgenerational and transactional sexual relations were reviewed.The review finds that engaging in sexual relations with older partners is the norm for adolescent girls. Sizeable proportions of girls' partners are more than six or 10 years older, although age differences with most current partners appear to be only a few years older. The data also reveal that select groups of girls, such as those who have become pregnant, have much older partners on average. There is a widespread transactional component to sexual relations for adolescent girls, and in some contexts, large proportions of girls have engaged in this type of relationship. It appears that, as adolescent girls mature, they engage in sexual relations with ever-older partners, and are more likely to have engaged in transactional sex. In addition, we find that men have large proportions of adolescent girls as non-marital sexual partners. However, due to the narrow definition of transactional sex in the survey questions, and the stigma of reporting exchange behaviors, these figures are likely to be underestimates.Several studies reveal significant relationships between unsafe sexual behaviors, HIV risk, and cross-generational sex. Three of these studies find that greater age differences between partners indicate a significant increase in adolescent girls' risk of HIV infection. Two additional studies find that unsafe behaviors -- including non-use of condoms and non-discussion of HIV with a partner -- are significantly linked to greater age differences between sexual partners. One study finds that transactions of greater value also have a significant effect on non-use of condoms.Although the motivations for adolescent girls to engage in sexual relationships with older men are varied and overlapping, gifts and other financial benefits was the major theme found. The motivations for financial rewards tend to be complex, ranging from economic survival to desire for status and possessions. Extreme household poverty as a motivator of sexual activity is described less often. Most studies point to girls' strategies to increase their life chances through education or work opportunities, or to pursue the enjoyment that goes along with adolescence and young adulthood. Gifts such as soap, perfume, dresses, meals out, and jewelry have become symbolic of a girl's worth and a man's interest, and girls who do not receive gifts in exchange for sexual relations are humiliated.Because of the limited negotiating power of adolescent girls with respect to sexuality and reproduction, sexual partnerships between adolescent girls and older men are fundamentally imbalanced, with men having more power. Girls appear to be able to negotiate relationship formation and continuance; for example, they can choose the types and number of partners they have, and can discontinue a relationship if gift-giving ceases. However, once in a sexual partnership, adolescent girls are less able to control sexual practices. Men appear to control the conditions of sexual intercourse, including condom and contraceptive use and the use of violence. Girls are not likely to insist on condom use for many reasons, including social norms and lack of selfperceived risk of HIV. On the whole, suggesting condom use jeopardizes their goals for the relationship, including the receipt of money and gifts.
Population Services International;
Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms.Methods: We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a regular (non-marital) or a casual partner. Respondents' reasons for not using a condom are shown by type of partner and by gender. Results: Males and females most frequently reported trusting their partner as the main reason for not using a condom in last sex with a marital or a regular (non-marital) partner. This suggests that low personal risk perception is the most important reason for not using a condom with a marital or a regular partner. A dislike of condoms is the most frequently cited reason for not using a condom with a casual partner. Respondents rarely cited the price of condoms as a barrier to condom use. Lack of condom availability was also rarely cited as a reason for not using a condom, except to some degree by males in casual partnerships. The latter may be because of the unplanned nature of casual sex activity, rather than because condoms are not available. Conclusions: Behavior change campaigns encouraging sexually experienced people to accurately assess their personal risk of acquiring HIV should be complemented with marketing campaigns emphasizing the positive attributes of condoms.
Summarizes research findings specifically focused on youth and HIV/AIDS in Sub-Saharan Africa since 1995. Includes only substantive behavioral research studies.
Provides an overview of the sexual and reproductive health behavior and needs of men aged 15 to 54 in twenty-two Sub-Saharan African countries for which nationally representative survey data are available.
Pew Forum on Religion & Public Life;
Details results of a nineteen-country survey on religious beliefs and practices, knowledge of and views of other faiths, political and economic satisfaction, and views on democracy, extremism, religious law, the status of women, and other issues.
Food and Agriculture Organization of the United Nations (FAO);
The Food and Agriculture Organization of the United Nations and the International Fund for Agricultural development collaborated on this report on water and rural poverty in sub-Saharan Africa. The paper addresses the potential benefits of water initiatives under a livelihood approach, with special consideration to two major recommendations: that investments in water infrastructure must act in concert with political, institutional, market and other related concerns; and that interventions must be context-specific, given the vast heterogeneity in water use and needs among sub-Saharan African rural poor.
World Resources Institute (WRI);
How can the world adequately feed more than 9 billion people by 2050 in a manner that advances economic development and reduces pressure on the environment? This is one of the paramount questions the world faces over the next four decades. Answering it requires a "great balancing act" of three needs -- each of which must be simultaneously met. First, the world needs to close the gap between the food available today and that needed by 2050. Second, the world needs agriculture to contribute to inclusive economic and social development. Third, the world needs to reduce agriculture's impact on the environment. The forthcoming 2013-14 World Resources Report, Creating a Sustainable Food Future, seeks to answer this question by proposing a menu of solutions that can achieve the great balancing act. "Achieving Replacement Level Fertility" profiles one of these solutions or "menu items," and is an installment in a series of working papers leading up to the World Resources Report. Since the 1980s, the World Resources Report has provided decisionmakers from government, business, and civil society with analyses and insights on major issues at the nexus of development and the environment. For more information about the World Resources Report and to access previous installments and editions, visit www.worldresourcesreport.org
African Palliative Care Association;
These recommendations aim to inform the provision of spiritual care for people receiving palliative care in sub-Saharan Africaby providing evidence-based guidance for palliative care service providers. The recommendations are designed to be broad and adaptable to different local conditions, so that they are applicable across sub-Saharan Africa, and to complement and facilitate the attainment of the APCA standard on spiritual care.