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Luthuli S, Daniel M, Corbin JH. Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study. Int J Equity Health 2024; 23:59. [PMID: 38491440 PMCID: PMC10943907 DOI: 10.1186/s12939-024-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Partnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research. METHODS A qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders. FINDINGS The partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources - two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities. CONCLUSION Using the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.
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Affiliation(s)
- Silondile Luthuli
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Marguerite Daniel
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - J Hope Corbin
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
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Holt DH, Højlund H, Jensen HAR. Conflict and synergy in health promotion partnerships: a Danish case study. Health Promot Int 2023; 38:daab189. [PMID: 34918043 DOI: 10.1093/heapro/daab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intersectoral partnerships constitute a central approach in health promotion. By combining different perspectives, knowledge and resources from different sectors, partnerships are important for addressing complex health problems. When successful, intersectoral partnerships create synergy, which is suggested to be a proximal outcome that links partnership functioning to health effects. Nonetheless, partnerships are also difficult and time-consuming and may result in conflicts, hostility and power struggles. Such antagonist outputs are expected to produce negative results. However, conflicts may also be a source of valuable learning. This article explores the relationship between conflict and synergy in health promotion partnerships. The empirical material is derived from an evaluation of a 4-year Danish government partnership program. Data consist of survey data collected from 35 partnerships and in-depth qualitative case studies of 10 partnerships. The analysis was inspired by realist evaluation. The qualitative data were coded, and cases written up. Cross-case analysis was conducted and triangulated with survey data. Surprisingly, disagreements and conflicts of interests between partners were common and associated with synergy creation. Moreover, the partnerships' experiences of synergy were often linked to their attribution of differences rather than to common goals or value congruences. The study identifies that a potential for synergy lays in the productive confrontation between partners different perspectives. Moreover, a key mechanism enabling productive conflicts was inclusive dialog, in which the partners' differences were valued, and all voices were included. The study thus builds on the existing synergy literature and adds nuance to the understanding of conflicts in health promotion partnerships.
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Affiliation(s)
- Ditte Heering Holt
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen K 1455, Denmark
| | - Holger Højlund
- Center for Management, Organization and Society, VIA University College, Hedeager 2, Aarhus 8200 N, Denmark
| | - Heidi A R Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen K 1455, Denmark
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Nts'upa M, Mpeli MR, Hugo-van Dyk L. Factors influencing non-compliance with standards for medical male circumcision in Lesotho. Nurs Open 2023. [PMID: 36940167 DOI: 10.1002/nop2.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 03/21/2023] Open
Abstract
AIM Medical male circumcision (MMC) standards are critical in promoting clients' safety and quality care. The aim is to report on factors that influence non-compliance with standards for MMC in the Lesotho context. DESIGN A qualitative, explorative, descriptive research design was used. METHOD Four focus group interviews were held with 19 purposively selected registered nurses providing routine MMC for one year or more. RESULTS Three themes emerged namely: knowledge of quality standards, barriers to compliance, and perceived enabling working environment. Findings highlight barriers such as infrastructure, the high targets that are set for programmes, and societal and cultural issues. Fatigue and burnout were prevalent among MMC providers due to workload. These providers stated carelessness in their work was brought on by overconfidence in their skills, leading to poor compliance with quality standards. PUBLIC CONTRIBUTION Implementing public health interventions in a clinical setting requires careful planning to respond to epidemics.
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Affiliation(s)
- Mamokete Nts'upa
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Moliehi R Mpeli
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lizemari Hugo-van Dyk
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Tanyanyiwa TA, Chimhutu V. Strengthening Cultural Competence in Health Professionals Through Partnerships: A Case Study of a Health Collaborative Exchange Between Malawi and Norway in Trauma Care and Emergency Medicine. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221115263. [PMID: 36282080 PMCID: PMC9608186 DOI: 10.1177/00469580221115263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
North-South partnerships have been identified as one way of solving some of the challenges in health sectors globally. Norway and Malawi have one such partnership in trauma and emergence care. Lack of trauma care and emergency medicine is a major public health concern worldwide. This results in substantial loss to individual, families, and society. The study follows this partnership between Norway and Malawi, investigating on its socio-cultural benefits, and on how this contributes to the health professionals' cultural competence. A qualitative case study was chosen for this study, 20 semi-structured interviews were conducted with health professionals and coordinators of the program. Interviews were conducted digitally using platforms such as Zoom and WhatsApp. Interviews were collected between the period of December 2020and February 2021. We found out that exchange participants from both countries largely reported positive experiences. Their experiences centered around their interactions and encounters with patients, patients' relatives, and colleagues at host institutions. Participants reported a better understanding on health seeking behaviors in different contexts, the importance of communication with both patients and colleagues, and teamwork. In addition, the study revealed the importance on perceptions around identities such as race and gender and how these impact on health professionals' interactions with patients. We also found out that although working in a different socio-cultural environment was reported as challenging, it was experienced as enriching and rewarding in terms of building and developing cultural competence. The study concludes that North-South health professionals exchange partnerships can be a viable vehicle for developing and naturing cultural competence in health professionals, however, such programs need to invest in preparing the exchange participants to be ready for the challenges that lies ahead in host institutions and countries.
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Affiliation(s)
- Takunda Archlove Tanyanyiwa
- University of Bergen, Bergen, Norway,Takunda Archlove Tanyanyiwa, Department of Health Promotion and Development, University of Bergen, Postbox 7807, Bergen 5020, Norway.
| | - Victor Chimhutu
- University of Bergen, Bergen, Norway,Inland Norway University of Applied Sciences Elverum, Norway
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Rosen JG, Carrasco MA, Traub AM, Kumoji E‘K. Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:314-323. [PMID: 34905454 PMCID: PMC8994851 DOI: 10.2989/16085906.2021.2006727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Reaching ambitious voluntary medical male circumcision (VMMC) coverage targets requires a deeper understanding of the multifaceted processes shaping men's willingness to access VMMC. Guided by the Ideation Model for Health Communication, this population-based study identifies correlates of Zambian men's future VMMC intentions. Multistage cluster sampling was used to identify households with adult men in 14 districts. Multivariable Poisson regression with robust standard errors modelled associations of future VMMC intent with ideational factors (e.g. perceived benefits and barriers) and sexual behaviours respectively. Forty per cent (40%) of uncircumcised men (N = 1 204) expressed future VMMC intentions. In multivariable analysis, VMMC intent was associated with secondary education or higher (Adjusted Prevalence Ratio [APR] 1.30, 95% Confidence Interval [95% CI]: 1.02-1.66), perceiving VMMC to increase sexual satisfaction (APR 1.45, 95% CI: 1.11-1.89), reporting distance to services as a barrier to VMMC uptake (APR = 0.54, 95% CI: 1.27-1.87), unprotected last sex (APR 1.54, 95% CI: 1.11-2.14), and ≥ 2 sexual partners in the past 12 months (APR 1.45, 95% CI: 1.05-1.99). Being aged ≥ 45 years (vs 18-24 years: APR 0.23, 95% CI: 0.13-0.40) and perceiving that circumcision: (1) is unimportant (APR 0.71, 95% CI: 0.51-0.98); (2) is incompatible with local customs (APR 0.41, 95% CI: 0.18-0.94); or (3) reduces sexual satisfaction (APR 0.10, 95% CI: 0.02-0.62) were inversely associated with future VMMC intent. Demand-creation efforts must confront salient cognitive and social barriers to VMMC uptake, including concerns around incompatibility with local customs. Simultaneously, promotional efforts should emphasise relevant VMMC benefits beyond HIV prevention that resonate with men (e.g. penile hygiene) without reinforcing harmful gender norms.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Maria A Carrasco
- Office of Family Planning and Reproductive Health, United States Agency for International Development, Washington DC, USA
| | - Ariana M Traub
- Office of HIV/AIDS, United States Agency for International Development, Washington DC, USA
| | - E ‘Kuor Kumoji
- Research and Evaluation Division, Johns Hopkins Center for Communication Programs, Baltimore, USA
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Keetile M. An assessment of sexual risk behaviours among circumcised and uncircumcised men before and after the implementation of the safe male circumcision programme in Botswana. AIDS Care 2020; 32:1594-1601. [PMID: 32449384 DOI: 10.1080/09540121.2020.1769830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV/AIDS prevalence is still high in Botswana. The main aim of this study was to assess and compare sexual risk behaviours of circumcised and uncircumcised men before and after the launch of the safe male circumcision programme. Data used for analyses were derived from the 2008 and 2013 Botswana AIDS Impact Surveys. Modified Poisson regression analysis was used to obtain prevalence ratios (PR) as measures of association between circumcision status and multiple sexual partners, transactional sex, inconsistent condom use and intergenerational sex. The proportion of circumcised men increased two times between 2008 (12.5%) and 2013 (25.2%). Prevalence of multiple sexual partnerships was high among uncircumcised than circumcised (54.6% vs. 46.4%) men in 2008, but in 2013 after the introduction of the SMC programme it was slightly high among circumcised men than uncircumcised men (23.2 vs. 21.8%). In the adjusted analyses, being circumcised was significantly associated with having multiple sexual partners (2008=adjusted PR=1.31, CI=1.10-1.57; 2013= adjusted PR=1.12, CI=1.01-1.41) and transactional sex (2008=adjusted PR=1.98, CI=1.26-3.11; 2013=adjusted PR=1.60, CI=1.09-1.22) for both survey periods. These results indicate the need to continuously sensitise and encourage men to stop multiple sexual partnerships and transactional sex. Moreover, there is need to encourage all men to use condoms consistently.
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Affiliation(s)
- Mpho Keetile
- Department of Population Studies, University of Botswana, Gaborone, Botswana
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Shi C, Li M, Dushoff J. Traditional Male Circumcision is Associated with Sexual Risk Behaviors in Sub-Saharan Countries Prioritized for Male Circumcision. AIDS Behav 2020; 24:951-959. [PMID: 30955178 DOI: 10.1007/s10461-019-02473-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To understand the sexual risk behavior of men with traditional male circumcision and medical male circumcision in the context of the World Health Organization's (WHO) campaign for voluntary medical male circumcision (VMMC) scale-up, we investigated ten countries prioritized for the scale-up from the Demographic and Health Surveys. Male respondents aged 15-49 were selected. Ordinal regression was used to analyze the relationship between three sexual risk behaviors-condom use with non-cohabiting partners, number of non-cohabiting partners, and partner type-and circumcision status (traditionally circumcised before and after the VMMC scale-up, medically circumcised before and after the scale-up, and not circumcised), while controlling for social demographic covariates. We found evidence that some sexual risky behavior, specifically lower condom use and higher number of sexual partners, was associated with traditional circumcision. This finding suggests that messages about the protective effect of male circumcision may not have reached men with traditional circumcision. We suggest that WHO's VMMC campaign should include communities where traditional male circumcision is popular. We looked for, but did not find, evidence of differences between groups circumcised at different times, which could have indicated sexual risk compensation.
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