That these issues are inextricably linked has been recognised recently by a number of researchers... more That these issues are inextricably linked has been recognised recently by a number of researchers and activists who have begun to illustrate the burden that women bear being at the nexus of gender inequality, discrimination, poverty and HIV/AIDS. They are the fastest-growing group of people living with HIV/AIDS (UNAIDS 2001a), with Human Rights Watch estimating that in certain areas of Eastern and Southern Africa the rate of infection among girls aged fifteen to seventeen is between four and seven times higher than that of boys in the same age group (Human Rights Watch, 2002).
Background Gender equality remains an outstanding global priority, more than 25 years after the l... more Background Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. Methods A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and a...
International Journal of Health Policy and Management
Background: Youth participation makes an essential contribution to the design of policies and wit... more Background: Youth participation makes an essential contribution to the design of policies and with the appropriate structures, and processes, meaningful engagement leads to healthier, more just, and equal societies. There is a substantial gap between rhetoric and reality in terms of youth participation and there is scant research about this gap, both globally and in South Africa. In this paper we examine youth participation in the Adolescent and Youth Health Policy (AYHP) formulation process to further understand how youth can be included in health policy-making. Methods: A conceptual framework adapted from the literature encompassing Place, Purpose, People, Process and Partnerships guided the case study analysis of the AYHP. Qualitative data was collected via 30 in-depth, semi-structured interviews of policy actors from 2019-2021. Results: Youth participation in the AYHP was a ‘first’ and unique component for health policy in South Africa. It took place in a fragmented policy lands...
Additional file 1. Search terms for systematic review of sexual and reproductive health intervent... more Additional file 1. Search terms for systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings.
Additional file 1. Supplementary file 1: Summary sentences behind scoring the extent to which att... more Additional file 1. Supplementary file 1: Summary sentences behind scoring the extent to which attention is paid to adolescents in the first 11 countries involved in the Global Financing Facility.
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016–30) emphasi... more The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016–30) emphasize that all women, children and adolescents ‘survive, thrive and transform’. A key element of this global policy framework is that gender equality is a stand-alone goal as well as a cross-cutting priority. Gender inequality and intersecting social and structural determinants shape health systems, including the content of policy documents, with implications for implementation. This article applies a gender lens to policy documents by national government bodies that have mandates on adolescent health in South Africa. Data were 15 policy documents, authored between 2003 and 2018, by multiple actors. The content analysis was guided by key lines of enquiry, and policy documents were classified along the continuum of gender blind to gender transformative. Only three policy documents defined gender, and if gender was addressed, it was mostly in gender-sensitive ways, at times gender specific, b...
Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take st... more Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take stock of the social and structural determinants of adolescent health. Those born in democratic South Africa, commonly known as the ‘Born Frees’, are perceived to be able to realise equal rights and opportunities, yet many factors constrain their lives. In bringing together approaches to understanding context in health policy and systems research and the social determinants of health, the paper develops a conceptual framework to guide the narrative review examining the key contextual social and structural determinants of adolescent health in South Africa. Illustrative examples drawing from 65 papers from public health and the social sciences describe and link these determinants across micro, meso and macro levels of society, their global determinants, and their intersections with compounding axes of power and inequality. At a micro level individual adolescent sexual and gender identities ar...
Adolescents are an increasing proportion of low and middle-income country populations. Their comi... more Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multi...
The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds b... more The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from progr...
Background Young people including adolescents face barriers to healthcare and increased risk of p... more Background Young people including adolescents face barriers to healthcare and increased risk of poor sexual and reproductive health (SRH), which are exacerbated in humanitarian settings. Our systematic review assessed the evidence on SRH interventions for young people including adolescents in humanitarian settings, strategies to increase their utilisation and their effects on health outcomes. Methods We searched peer-reviewed and grey literature published between 1980 and 2018 using search terms for adolescents, young people, humanitarian crises in low- and middle- income countries and SRH in four databases and relevant websites. We analysed literature matching pre-defined inclusion criteria using narrative synthesis methodology, and appraised for study quality. Findings We found nine peer-reviewed and five grey literature articles, the majority published post-2012 and mostly high- or medium-quality, focusing on prevention of unintended pregnancies, HIV/STIs, maternal and newborn he...
Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap ... more Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.Methods: We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results: While several country documents signal understanding and investment in adolescent health as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to in...
Health systems are critical for health outcomes as they underpin intervention coverage and qualit... more Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring hea...
Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while ... more Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while pregnant. South Africa has the highest prevalence of FASD in the world. We review the social determinants underpinning FASD in South Africa and add critical insight from an intersectional feminist perspective. We undertook a scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. Drawing from EBSCOhost and PubMed, 95 articles were screened, with 21 selected for analysis. We used the intersectionality wheel to conceptualize how the social and structural determinants of FASD identified by the literature are interconnected and indicative of broader inequalities shaping the women and children affected. Key intersecting social determinants that facilitate drinking during pregnancy among marginalized populations in South Africa documented in the existing literature include social norms and knowledge around drinking and dr...
That these issues are inextricably linked has been recognised recently by a number of researchers... more That these issues are inextricably linked has been recognised recently by a number of researchers and activists who have begun to illustrate the burden that women bear being at the nexus of gender inequality, discrimination, poverty and HIV/AIDS. They are the fastest-growing group of people living with HIV/AIDS (UNAIDS 2001a), with Human Rights Watch estimating that in certain areas of Eastern and Southern Africa the rate of infection among girls aged fifteen to seventeen is between four and seven times higher than that of boys in the same age group (Human Rights Watch, 2002).
Background Gender equality remains an outstanding global priority, more than 25 years after the l... more Background Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. Methods A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and a...
International Journal of Health Policy and Management
Background: Youth participation makes an essential contribution to the design of policies and wit... more Background: Youth participation makes an essential contribution to the design of policies and with the appropriate structures, and processes, meaningful engagement leads to healthier, more just, and equal societies. There is a substantial gap between rhetoric and reality in terms of youth participation and there is scant research about this gap, both globally and in South Africa. In this paper we examine youth participation in the Adolescent and Youth Health Policy (AYHP) formulation process to further understand how youth can be included in health policy-making. Methods: A conceptual framework adapted from the literature encompassing Place, Purpose, People, Process and Partnerships guided the case study analysis of the AYHP. Qualitative data was collected via 30 in-depth, semi-structured interviews of policy actors from 2019-2021. Results: Youth participation in the AYHP was a ‘first’ and unique component for health policy in South Africa. It took place in a fragmented policy lands...
Additional file 1. Search terms for systematic review of sexual and reproductive health intervent... more Additional file 1. Search terms for systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings.
Additional file 1. Supplementary file 1: Summary sentences behind scoring the extent to which att... more Additional file 1. Supplementary file 1: Summary sentences behind scoring the extent to which attention is paid to adolescents in the first 11 countries involved in the Global Financing Facility.
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016–30) emphasi... more The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016–30) emphasize that all women, children and adolescents ‘survive, thrive and transform’. A key element of this global policy framework is that gender equality is a stand-alone goal as well as a cross-cutting priority. Gender inequality and intersecting social and structural determinants shape health systems, including the content of policy documents, with implications for implementation. This article applies a gender lens to policy documents by national government bodies that have mandates on adolescent health in South Africa. Data were 15 policy documents, authored between 2003 and 2018, by multiple actors. The content analysis was guided by key lines of enquiry, and policy documents were classified along the continuum of gender blind to gender transformative. Only three policy documents defined gender, and if gender was addressed, it was mostly in gender-sensitive ways, at times gender specific, b...
Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take st... more Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take stock of the social and structural determinants of adolescent health. Those born in democratic South Africa, commonly known as the ‘Born Frees’, are perceived to be able to realise equal rights and opportunities, yet many factors constrain their lives. In bringing together approaches to understanding context in health policy and systems research and the social determinants of health, the paper develops a conceptual framework to guide the narrative review examining the key contextual social and structural determinants of adolescent health in South Africa. Illustrative examples drawing from 65 papers from public health and the social sciences describe and link these determinants across micro, meso and macro levels of society, their global determinants, and their intersections with compounding axes of power and inequality. At a micro level individual adolescent sexual and gender identities ar...
Adolescents are an increasing proportion of low and middle-income country populations. Their comi... more Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multi...
The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds b... more The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from progr...
Background Young people including adolescents face barriers to healthcare and increased risk of p... more Background Young people including adolescents face barriers to healthcare and increased risk of poor sexual and reproductive health (SRH), which are exacerbated in humanitarian settings. Our systematic review assessed the evidence on SRH interventions for young people including adolescents in humanitarian settings, strategies to increase their utilisation and their effects on health outcomes. Methods We searched peer-reviewed and grey literature published between 1980 and 2018 using search terms for adolescents, young people, humanitarian crises in low- and middle- income countries and SRH in four databases and relevant websites. We analysed literature matching pre-defined inclusion criteria using narrative synthesis methodology, and appraised for study quality. Findings We found nine peer-reviewed and five grey literature articles, the majority published post-2012 and mostly high- or medium-quality, focusing on prevention of unintended pregnancies, HIV/STIs, maternal and newborn he...
Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap ... more Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.Methods: We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results: While several country documents signal understanding and investment in adolescent health as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to in...
Health systems are critical for health outcomes as they underpin intervention coverage and qualit... more Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring hea...
Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while ... more Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while pregnant. South Africa has the highest prevalence of FASD in the world. We review the social determinants underpinning FASD in South Africa and add critical insight from an intersectional feminist perspective. We undertook a scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. Drawing from EBSCOhost and PubMed, 95 articles were screened, with 21 selected for analysis. We used the intersectionality wheel to conceptualize how the social and structural determinants of FASD identified by the literature are interconnected and indicative of broader inequalities shaping the women and children affected. Key intersecting social determinants that facilitate drinking during pregnancy among marginalized populations in South Africa documented in the existing literature include social norms and knowledge around drinking and dr...
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Papers by Tanya Jacobs