The varied perspectives of organisational effectiveness: What's at stake for early childhood development programmes in Rwanda?

Within global health and development, dissatisfaction with nongovernmental organisations' effectiveness (NGOs) is an increasingly pervasive aspect of programming. Today, the international community no longer accepts that NGOs are doing what they claim. This change in expectations has emphasised the importance of measuring organisational effectiveness for improved health and development impact. Using New Institutionalism as a theoretical framework, we investigated how institutional norms and expectations influence the adoption of structures and processes by NGOs, and Early Childhood Development (ECD) programming effectiveness in Rwanda - since little research connects these concepts. We employed qualitative methods: 45 in-depth interviews and 6 focus group discussions. Findings revealed a misalignment of 'organizational effectiveness' across scales, from global to local. Findings stress that, effectiveness, though an expectation of the institutional environment, may not be a valid construct for NGOs, generating implications for ECD programming. Findings also indicate measurement of global health interventions generally and the notion of effectiveness specifically can yield adverse implications for ECD programming. These findings are relevant for researchers and practitioners trying to better understand organisational effectiveness for ECD programmes because they suggest that effectiveness is socially constructed and measured differently across the different scales.

'Eventually I wanted something more': sexual self-reflections of South African women engaged in transactional sexual relationships with blessers.

The term 'blesser' emerged from social media in South Africa, typically denoting an older man who provides a younger woman with money and/or luxury items in exchange for sex. Within an increasingly consumerist culture, such transactional sexual relationships hold powerful appeal, and remain highly prevalent. An estimated one in three Black South African women have engaged in transactional sex. While these liaisons are associated with negative health outcomes for women, especially in high HIV prevalence settings, attention to how they affect Black women's sexuality is under-studied-especially with respect to emotional and sexual development-an important part of sexual rights and wellbeing. We used qualitative methods to investigate 22 women's experiences with blessers. A sexual rights framework was utilised to explore human rights dimensions. We found women's rights to engage in consensual sex, pursue sexual pleasure and ensure their bodily integrity were compromised. Many participants recognised the psychological costs and limitations of engaging in blesser relationships. Women communicated that they realised such partnerships failed to meet their emotional and relationship needs. Against the backdrop of structural gender inequality, Black South African women's narratives should inform research, programmes and educational interventions aimed at advancing women's sexual development, rights and wellbeing.

Getting to zero HIV/AIDS in sub-Saharan Africa: Understanding perceptions of locals using the social determinants of health framework.

This study explored a community perception of the facilitators and inhibitors of Getting to Zero (GTZ) in rural Zambia, sub-Saharan Africa. Data were collected in 2017. We use the Social Determinants of Health framework to guide organisation of key themes emerging from semistructured, focus group interviews with community members (N = 52). Data were analysed through an iterative descriptive/thematic approach which allowed for the highlighting of key themes. Emerging themes point to the significance of (a) individual, (b) sociocultural, (c) environmental and (d) economic factors, for example, treatment adherence, gender norms, food security and access to health care as important in GTZ. Implications for policy, practise and scholarship are suggested.

Experience of religion and spirituality among socially marginalised people living with HIV in Mississippi.

African Americans in Mississippi have the highest HIV-related mortality and poverty rates in the USA, and they tend to be religious. Attitudes toward gender and sexuality are changing, yet few studies have investigated religion and spirituality among special populations living with HIV. Using grounded theory and qualitative methods, we investigated the experience of health and illness of a low-income, socially marginalised population living with HIV in two locations of Mississippi in 2015. In a context of high stigma and HIV-related health disparities, individuals turned, or returned, to religion, church and spirituality as sources of community and strength, which also motivated safer health behaviours. Findings underscore how religion and spirituality are enabling social determinants of health that are under-explored, untapped, potentially culturally acceptable, sustainable interventions at the community-level. We posit, given diminished funding for community-based services, the most significant influence churches could exert is in decreasing HIV stigma. Given the current US plan to end HIV by 2030, with appropriate stakeholder participation, the role of religion, spirituality and clergy could be further amplified via linkage to care providers and the 'normalisation' of the HIV discourse, to address disparities and improve the health of African Americans.

Towards ending the US HIV epidemic by 2030: Understanding social determinants of health and HIV in Mississippi.

The disproportionate burden of HIV-related inequities borne by African Americans in the US South amplifies the role of social determinants of health (SDH) in shaping social patterning of illness. Despite some attention, SDH remain overlooked in a biomedically oriented, federal HIV policy. Mississippi is the poorest state with the worst HIV outcomes, nationally. Using qualitative methods, we investigated how primarily African American, HIV-positive Mississippians experienced SDH and health inequities in their daily lives. Employing grounded theory and in-depth interviews (n = 25) in an urban and rural site in 2015 yielded these findings: (1) absence of an enabling structural environment; (a) HIV-stigma constructed via social discourse; (b) lack of psycho-social support and HIV education; (c) insufficient economic and social support resources; and (2) presence of family support for coping. Due to stigma, being HIV-positive seemed to lead to further status loss; diminished social position; reduced life chances; and contractions in particular freedoms. Stigma further compounded existing inequalities - contributing to the moral, social experience of those living with HIV. Trump's plan to end HIV by 2030 creates the opportunity to rethink the biomedical-paradigm and fully engage SDH - using social science theory and methods that address multi-level social determinants in ways that are also policy-responsive.