Resilience among older caregivers in rural Namibia: The role of financial status,social support and health

Background: Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Method: Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Results: Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Discussion: Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

Healthcare in India: Changing the Financing Strategy

The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one‐fifth of health expenditure being publicly financed. India has large‐scale poverty and yet the main source of financing healthcare is out‐of‐pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to over‐emphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.     

An Ethnography of Social Assistance to Ethiopian Children by Non‐governmental Organizations: Types,Adequacy and Predictability

Although in Africa social assistance is provided by both state and non‐state actors, systematic research has paid little attention to the aggregate services provided by the latter. This is so despite the significance of the aggregate size, diversity, investment and coverage of the services provided by non‐state actors in the continent. This article reports on an ethnographic assessment of the nature of aggregate social assistance services provided to Ethiopian children by non‐governmental organizations (NGOs) in Africa, taking the cases of services provided by 38 NGOs that run 52 social protection interventions in Ethiopia's capital, Addis Ababa. Data collection employed semi‐structured interviews with officers of the 38 NGOs and exploratory interviews with 25 key informants. Analysis of the ethnographic data revealed that social assistance by NGOs was insufficient, unpredictable, erratic and of inferior quality and, hence, failed to meet the conditions that could make social assistance an effective instrument for breaking the intergenerational transmission of poverty. The analysis also revealed that the same social assistance was not large enough to undermine recipients' commitment to work. The article concludes by recommending the establishment of a social welfare system in Ethiopia that can effectively regulate social assistance in order to ensure the quality of design and implementation, and the integration of discreet social assistance projects.     

Changing Healthcare System Types

This article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.     

Culture wars in South Australia: the sex education debates

School sexuality education has been a component of Australia's successful and internationally recognized HIV/AIDS strategy since the 1980s and has been well accepted in the community. However South Australia is experiencing a re‐emergence of opposition to school sexuality education orchestrated by groups associated with the United States‐based Christian Right. In this paper I will outline sex education policy developments in Australia and the United States as a framework for discussing the controversy generated around the Sexual Health and Relationships Education (SHARE) program in South Australia in 2003. In doing so I give attention to the similarities between the strategies deployed by the opponents of SHARE and those used to install abstinence‐only‐until‐marriage sex education as national policy in the United States. I will argue that, rather than a phenomenon indigenous to South Australia, these debates are part of an international movement to progress the political goals of the Christian Right.     

Enthusiasm crushed by apathy: the survival condition of the NGOs under a social management system in Mainland China

The Chinese government is currently endeavouring to establish a new social management system, with the participation of the government and different parties in society, among whom NGO participation in social management is considered the essential approach for social management system innovation. The post-disaster relief and reconstruction of the Wenchuan earthquake in 2008 left an indelible mark in the developmental history of Chinese NGOs, and provides an opportunity for us to examine the survival condition of NGOs. For this paper, we use a qualitative research method to trace the four-year relief and reconstruction process of a severely afflicted township in Sichuan Province during the Wenchuan earthquake in 2008, and examine the work of NGOs at different stages of the post-disaster operation, the role that NGOs played during the relief and reconstruction process, and the survival conditions of NGOs in China's contemporary social management pattern. By analysing the obstacles that NGOs have encountered in the participation of social management, this paper offers suggestions for the innovation of the social management system.     

Adoption in South Africa: trends and patterns in social work practice

This paper reports findings from a research study on adoption in South Africa conducted in 2009. The research included secondary data analysis of the South African National Adoption Register to establish trends and patterns of adoption in South Africa between 2004 and 2009, and primary data collection through qualitative interviews with key informants in public and private social welfare services to explore attitudes, knowledge and experiences of social work practice related to adoption. The quantitative findings report the number of national and international adoptions along with trends and socio‐demographic patterns of national adoptions. Qualitative findings report on social work practice, systemic barriers and social worker attitudes as barriers to improved social work practice around national adoptions. The paper highlights comparisons to adoption literature in the USA, a country with a similar legislative framework and cultural complexities, but significantly more resources for implementation. Recommendations are offered for social work practice, national data collection and policy implementation efforts to support efforts to increase adoption.     

Healthcare funding problems in Algeria

During the 1990s, a period of economic crisis, the health sector was involved in Algeria's broader transition to a market economy and the start of the process of privatization, with the result that the general level of health was affected by the structural adjustment policy pursued. Financing healthcare is an extremely serious problem. Seen as the primary source of difficulties in the national health system, it has become a major concern for both the authorities and the general public. Because of the difficulties, the healthcare needs of the population cannot be met, even though state, social security and household spending are constantly on the increase. This article attempts to analyse the funding mechanisms and the level of healthcare expenditure in Algeria.     

The influence of faith‐based organisations on Australian social policy

This historical overview explores the crucial and changing relationships between faith‐based organisations and governments, not only in the implementation of social services but also in the formation of social policy. Historically Australian governments have left large areas of social provision to the non‐government sector. For example, income support for the unemployed was not taken up by governments until World War II and income support for sole parents remained largely a responsibility for non‐government organisations (NGOs) until the 1970s. Prior to governments taking responsibility for income support, most of these NGOs were religious organisations surviving on donations, philanthropic support and limited government funding. It is argued that the dominant, semi‐public role of religious organisations in service delivery and social policy formation is an important but largely overlooked aspect of the Australian historical experience.     

Supporting HIV/AIDS affected families and children: the case of four Chinese counties

This article focuses on the impact that HIV/AIDS has on children in China and the social support provided to these children. The research finds that the consequences of HIV/AIDS are serious: the entire environment in which children develop is adversely affected by the disease. These negative socio-economic effects are due not only to HIV/AIDS, but also to the social discrimination and exclusion experienced by affected communities and families. Local governments and societies have started to provide support to HIV/AIDS-affected children and work to reduce the social exclusion they suffer. However, many challenges and problems still lie ahead.     

“不完全合作”：NGO联合行动策略——以“5·12”汶川地震NGO联合救灾为例

中国NGO的发展策略越来越引起广泛关注,本文以“5·12”汶川地震NGO联合救灾行动为例,着重探讨当前中国NGO联合行动的“不完全合作”问题。本文认为,不完全合作是NGO在面对内外部制度约束和组织限制条件下的主动策略性行动选择,具体策略机制表现为联合行动目标的自我约束、有限的组织参与和弹性的组织形式等三方面。NGO不完全合作策略的产生是由外部政治机会空间有限、组织关系网络的非正式性,以及组织合作意愿不完全等组织内外部因素的共同形塑而成。本文还指出,在当前整体限制性的制度环境下,正是这种不完全合作策略使得NGO联合救灾在面对各种挑战的情况下成为可能,但也因为合作的不完全性,使得联合行动难以持续。NGO进一步的持续合作还需要新的组织模式。     

“This rabid fight for survival”: Small NGO manager's experiences of funding reform

This article explores the experiences of small Non‐Government Organisation (NGO) managers who are experiencing significant funding reforms. Drawing on a desk review of the literature, and semi‐structured interviews with managers of small NGOs in a case study site of Glebe, New South Wales, we present some of the issues arising from these new modes of funding governance. Findings revealed that funding is increasingly complex, with variations in timeframe, funder and geographic boundaries. The short‐term nature of funding contributed to NGO managers stating that they have been operating in a “survival” mode characterised by a high‐level uncertainty. Changes to funding regimes have led to a need to seek out future funding, engage in competitive tendering processes and comply with multiple and growing funding reporting requirements – tasks that are time‐consuming and at times stressful. Overall, managers experienced overwhelming funding complexity, which impeded the NGO's ability to focus on the needs of clients — an outcome which is surely antithetical to the aims of the various reforms to funding governance.     

Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?

In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self–employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self–employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self–employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare.     

Does family still matter? Public and private transfers in emerging welfare state systems in a comparative perspective

Kim JW, Choi YJ. Does family still matter? Public and private transfers in emerging welfare state systems in a comparative perspective Int J Soc Welfare 2011: 20: 353–366 © 2010 The Author(s), International Journal of Social Welfare © 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. While the role of the family has been a distinctive feature of East Asian welfare systems, rapid social policy development and reforms in South Korea and Taiwan over the last two decades have led to an increase in public welfare. Yet, despite a growing number of studies, little is known about the role of family support – private transfers – and public programmes in the performance of state welfare. This article reports on a comparative analysis of the role of public and private transfers aimed at poverty and inequality reduction in 12 Western and two East Asian states employing the Luxemburg Income Study data set. Results indicate that, in contrast to the West, private transfers that rest primarily on family support remain more important than public transfers in reducing income inequality and poverty in South Korea and Taiwan.     

Room for climate advocates in a coal‐focused economy? NGO influence on Australian climate policy

Many Australian environmental non‐government organisations (NGOs) have campaigned for greater political action and community awareness on human‐induced climate change for almost two decades. Australian emissions are the highest per person in the world, yet the Government's response is heavily influenced by the economically‐significant fossil fuel industry. NGO campaigners are sceptical of their campaigns' effectiveness. This paper presents three methods for evaluating the effectiveness of NGO climate change campaigns: Moyer's Movement Action Plan, Schumaker's Assessment of Political Effectiveness, and a document analysis of the influence of NGO submissions to climate policy processes. Evaluation is critical for NGO campaigns to improve their effectiveness, and evaluation criteria and methods should ideally be designed in parallel with the campaign strategy. Using these evaluation methods, it is evident that Australian NGO campaigns on climate change have been effective.     

Impacts of HIV/AIDS on poor and socially marginalised former commercial plasma donors in rural central China: social work implications

Little is known about the impact of HIV/AIDS on people who acquired the virus through former commercial plasma donations in the mid-1990s in rural Central China. The objective of this study was to examine socioeconomic impacts associated with HIV/AIDS on poor farm workers and their families, with a particular focus on economic hardships and social exclusion. The findings from 30 interviews reveal the profound effects of deteriorating health on labour power loss. The well-being of people living with HIV/AIDS was immensely affected by the loss of income, debts due to health-related expenses and a lack of alternate sources of income. Social exclusion and HIV/AIDS-related stigma remain significant issues in a workplace, funerals, and weddings. This article highlights the economic impacts of HIV/AIDS on China’s rural population and provides recommendations for social workers to mitigate the impacts of social exclusion on vulnerable rural households in China.     

Improving Development Ownership Among Vulnerable People: Challenges of NGOs’ Community Empowerment Projects in Bangladesh

This paper exposed the major challenges that the non‐governmental organizations (NGOs) face in improving development ownership among vulnerable people in community empowerment projects in Bangladesh. The finding, based on a qualitative research approach, used multi‐method data collection procedures. Data were collected from two NGOs, Proshika and Practical Action Bangladesh (PAB), working with two vulnerable communities—blacksmiths and goldsmiths. The results showed that NGOs faced a number of challenges, including lack of understanding about the local context, initiatives to localize global development tools, developing partnership, and space for local people in the development processes. The paper argued that, without securing development ownership, the NGOs’ activities toward community empowerment of vulnerable people would not be possible. The findings of the paper would be valuable guidelines for policy makers, development practitioners, NGO workers, and academicians.     

农村艾滋病患者的社会处境分析

了解艾滋病患者的社会处境对于把握艾滋病患者的真实需求,构建艾滋病患者的社会支持网络,预防和控制艾滋病的流行具有重要意义。本文以湖北农村艾滋病患者为例,从社会经济地位、家庭环境、社会舆论和社会政策的角度分析了艾滋病患者的社会处境。