Enhancing household soybean processing and utilization in the Eastern Province of Zambia, a concurrent triangulation study design.

The purpose of this study was to establish best ways of improving household soybean processing and utilization in selected districts in the Eastern Province of Zambia. This was a concurrent triangulation study design, nested with a cross sectional survey and barrier analysis. Up to 1,237 households and 42 key informants participated in the quantitative and qualitative studies respectively. Quantitative data was analysed using Stata MP 15 software (StataCorp, College Station, TX, USA). NVIVO QSR10 software (QSRInt, Melbourne Australia) was used to organize qualitative data which was later analysed thematically. In this study whole soybean processing and utilization in eastern province was at 48%. However, accessibility to soybean for household consumption throughout the year was negligible (0.29%). Based on the food systems an interplay of factors influenced soybean processing and utilization. In the food environment, a ready-made Textured Soya Protein mainly imported [1,030/1237(83%)] and a milled whole soybean-maize blend AOR 816.37; 95%CI 110.83 to 6013.31 were preferred. Reports of labour intensity, hard to cook properties, coarse milling and beany flavour with associated anti-nutrients negatively influenced whole soybean utilization. In the enabling environment, soybean production AOR 4.47; 95%CI 2.82 to 7.08 increased the chances of utilization. Lack of inputs, poor access to affordable credit and lack of ingredients were deleterious to utilization. Low coverage of existing projects and poor access to technologies were other adverse factors. Among the Socioeconomic factors, a higher social hierarchy shown by owning a bed AOR 1.75; 95%CI 1.22 to 2.49, belonging to the Chewa community AOR 1.16; 95%CI 1.08 to 0 1.25, gender of household head particularly male AOR 1.94; 95%CI 1.21 to 3.13, off farm income and livestock ownership were supportive to soybean utilization. Unfavourable factors were; belonging to any of the districts under study AOR 0.76; 95%CI 0.58 to 0.98, lack of knowledge (55.65%), low involvement of the male folks AOR 0.47; 95%CI 0.30 to 0.73 and belonging to a female headed household AOR 1.94; 95%CI 1.21 to 3.13. Age, time and household size constraints as well as unreliable soybean output markets, lack of land, poor soils in some wards and poor soybean value chain governance were other negative factors. Immediately in the food environment there is need to boost milling of whole soybean while strengthening cooking demonstrations, correct processing, incorporation of soybean in the local dishes and conducting acceptability tests. In the enabling environment, there should be access to inputs, affordable credit facilities and subsidized mineral fertilisers. Post-harvest storage, collective action with full scale community involvement and ownership should be heightened. Socioeconomic approaches should target promotion of soybean processing and utilization among all ethnic groups, participation of male folks and female headed households as well as advocating for increased nutrition sensitive social protection. In the medium or long term, capacity building, market development, import substitution agreements, creation of new products, development of cottage industries, information exchange and inter district trade as well as more public-private partnerships and more local private sector players should be bolstered. Lastly farm diversification should be supported.

Impact on child mortality of removing user fees: simulation model.

OBJECTIVE: To estimate how many child deaths might be prevented if user fees were removed in 20 African countries DESIGN: Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services. RESULTS: Elimination of user fees could prevent approximately 233,000 (estimate range 153,000-305,000) deaths annually in children aged under 5 in 20 African countries. CONCLUSION: Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.

One Million More: Mobilising the African diaspora healthcare professionals for capacity building in Africa

This report describes some of the interventions; debates; discussions and conclusions from the conference `Mobilising the African Diaspora Healthcare Professionals for Capacity Building in Africa'; which was held in London from 21-22 March 2006. Voices in the report come from many diverse stakeholders; including health ministers from Africa; civil society; donors and the diaspora. The conference was organised to create a stimulating and interactive forum to discuss the crisis in human resources for health; in an effort to influence national; regional and international policies for the promotion of sustainable skills capacity in Africa and to engage the African diaspora in innovative; practical steps to move the agenda forward. The report describes the nature of the problem; while examining the causes and possible ways forward; concluding with recommendations on how to plug the gap of one million healthcare professionals needed by Africa today; to reach its millennium Development Goals (MDGs) for health.3 2006 has been dedicated; by the World Health Organization (WHO); to human resources for health. The 2006 World Health Report focuses on the human resource crisis and is entitled Working Together for Health. It was launched in Zambia on 7 April; World Health Day. This report will be used as an advocacy tool in various international health fora (like the Commonwealth Health Ministers meeting and the World Health Assembly (WHA)) to ensure that the voices from this meeting are heard and are able to influence strategies and policy discussions. It must be noted; however; that while adequate representation cannot be secured in a short meeting and voices from such a diverse group will not be homogeneous; opportunities must be sought to harness the valuable skills of the diaspora. There are many innovative mechanisms described in this report; but it is only by involving the diaspora in context-specific planning; research; training; advocacy and policy formation that their support can be used to help strengthen Africa's health systems. The meeting heard calls for donors to fund the recommendations from the Commission for Africa to give more financial support to healthcare ($1-6bn for human resources and $9bn for strengthening health systems) while calling for African nations to meet their promised Abuja target of spending 15 per cent of their national budgets on health. The diaspora was asked to support national ministry plans while countries were advised to carry out detailed human resource gap analyses; and to use their consulates to develop databases for migrant health workers willing to return home to work. Positive retention policies - includingimproved salaries; working conditions; rural post incentives; enhanced career opportunities and improved mechanisms to return home - were put forward as ways to improve staff motivation andretention. The issues of HIV and conflict were highlighted along with poverty and economic policies as causal factors in a growing global health worker market. Save the Children UK called on the UK government to pledge 10 per cent ($100 million annually) of the $1bn needed; by 2007; to support the training and retention of 100;000 health workers in Africa as part restitution for the unjust subsidy the UK NHS and Department of Health receive from African health systems through health worker migration