Effectiveness and equity of the Tanzania National Voucher Scheme for mosquito nets over 10 years of implementation.

PubMed

Kramer, Karen; Mandike, Renata; Nathan, Rose; Mohamed, Ally; Lynch, Matthew; Brown, Nick; Mnzava, Ally; Rimisho, Wilhelmina; Lengeler, Christian

2017-06-15

The Tanzania National Voucher Scheme (TNVS) was a public private partnership managed by the Ministry of Health that provided pregnant women and infants with highly subsidized (long-lasting) insecticide-treated nets between 2004 and 2014. It was implemented in the context of the National Insecticide Treated Nets (NATNETS) Programme and was the main keep up strategy for vulnerable populations. The programme design was adjusted considerably over time to incorporate new evidence, shifting public health policies, and changing donor priorities. Three TNVS models can be distinguished: (1) the fixed discount; (2) the fixed top-up; (3) the hybrid voucher model. The changes improved equity and effectiveness, but also had a profound effect on how the programme was managed and implemented. The TNVS reached the majority of beneficiaries with vouchers, and significantly increased household ownership and use of LLINs. While two mass distribution campaigns implemented between 2009 and 2011 achieved universal coverage and equity, the TNVS ensured continuous protection of the vulnerable populations before, during and after the campaigns. The TNVS stimulated and maintained a large national retail network which managed the LLIN supply chain. The effectiveness of the TNVS was a function of several interdependent factors, including the supply chain of vouchers through the public health system; the supply chain of nets in the commercial sector; the demand for nets from voucher recipients; management and risk mitigation measures; and the influence of global and donor objectives. The TNVS was a highly innovative and globally influential programme, which stimulated the thinking around effectively and equitably distributing ITNs, and contributed directly to the evolution of global policy. It was a fundamental component of the NATNETS programme which protected a malaria-vulnerable population for over a decade.

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

PubMed

Kolandai-Matchett, Komathi; Landon, Jason; Bellringer, Maria; Abbott, Max

2018-03-06

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

What Does Low Proficiency in Literacy Really Mean? Adult Skills in Focus #2

ERIC Educational Resources Information Center

OECD Publishing, 2016

2016-01-01

In designing policies and programmes targeting populations with poor literacy skills, it is important to take into account differences in the level of these skills within and among these populations. For example, native speakers of the mainstream language may require different language-development training than non-native speakers; and most adults…

New developments in Indian space policies and programmes—The next five years

NASA Astrophysics Data System (ADS)

Sridhara Murthi, K. R.; Bhaskaranarayana, A.; Madhusudana, H. N.

2010-02-01

Over past four decades Indian space programme has systematically acquired capabilities in space technologies and implemented its programmes with a high level of focus on societal applications. It is developed into a multi-dimensional programme where its strategy is directed towards diverse stake holders and actors such as government, users and beneficiaries including general public, industrial suppliers as well as customers, academia and other space agencies/international organisations. Over the next five years, the Indian space programme has charted an ambitious set of policies and programmes that aim to enhance impacts on society. The major task is to enlarge and diversify the services delivered to a large section of population affected by income, connectivity and digital divides. While efficacy of application of space based systems have been proven in several fields such as tele-education, water resources management, improving productivity of land and out reaching quality health services and others, the crux of the problem is to evolve sustainable and scalable delivery mechanisms on a very large scale and extending over large geographical areas. Essentially the problem shifts from being predominately a technology problem to one of a composite of economic, cultural and social problems. Tackling such problems would need renewal of policies relating to commercial as well as public service systems. Major programmatic initiatives are planned in the next five years involving new and upgraded technologies to expand services from space to fill the gaps and to improve economic efficiency. Thrust is also given to science and exploration mission beyond Chandrayaan-1 and some initial steps for the participation in human space flight. This paper discusses the policy and strategy perspectives of the programmes planned by Indian Space Research Organisation over next five years.

Evaluating indirect and direct effects of eco-restoration policy on soil conservation service in Yangtze River Basin.

PubMed

Kong, Lingqiao; Zheng, Hua; Rao, Enming; Xiao, Yi; Ouyang, Zhiyun; Li, Cong

2018-08-01

The conservation impacts of policies that promote large-scale ecological restoration of ecosystem services and socio-economic development are well documented around the world. However, the effect of socio-economic development resulting from such policies on ecosystem services is rarely analysed, although it is important to do so if these policies are to be sustainable. We analysed the socio-economic impacts of soil conservation services from 2000 to 2015 in the Yangtze River Basin under the Grain to Green Programme (GTGP). Also we assessed the driving forces behind the programme: conservation policies, urbanization, agricultural development, and population growth. Our results show that during 2000-2015, cultivated area decreased by 7.5%, urban area increased by 67.5%, forest area increased by 2.1%, and soil erosion was reduced by 19.5%. The programme not only contributed significantly to an improvement in soil conservation services but also enhanced them significantly through faster urbanization. Furthermore, vegetation cover and crop yields increased synergistically, mainly due to high-efficiency agriculture that reduced the negative effect of the GTGP on agricultural production. Overall determining the indirect and direct effects of the GTGP on soil conservation and agricultural production are important for furthering our understanding of the long-term effects of ecological restoration policies, and the present study offers practical insights for ecological restoration of other watersheds. Copyright © 2018 Elsevier B.V. All rights reserved.

Social inequality in health: dichotomy or gradient? A comparative study of problematizations in national public health programmes.

PubMed

Vallgårda, Signild

2008-01-01

Recent public health programmes from four countries: Denmark, England, Norway, and Sweden, are studied to analyse how social inequality in health is described, explained and suggested to be tackled, i.e., the problematization or the discursive process whereby the issue is framed and made accessible to political action. Social inequality in health is defined in these programmes both as a disadvantaged minority with major health problems, in contrast to the rest of the population, i.e., as a dichotomy; and as a gradient in which health problems are seen as increasing with lower social class or educational level. The causes of health inequality are identified as behaviour, social relations and underlying social structures. Policies aimed at reducing health inequality can be characterized as either in accordance with a residual welfare state model, targeting the disadvantaged, or a universal model, addressing the whole population. All countries have policies that are mixtures of these problematizations, but with some systematic differences between the countries. In this field England resembles the Scandinavian countries, as much as they resemble each other dispelling the idea of a Nordic or Scandinavian welfare state model.

Canaries in the coal mine: Interpersonal violence, gang violence, and violent extremism through a public health prevention lens.

PubMed

Eisenman, David P; Flavahan, Louise

2017-08-01

This paper asks what programmes and policies for preventing violent extremism (also called 'countering violent extremism', or CVE) can learn from the public health violence prevention field. The general answer is that addressing violent extremism within the wider domain of public health violence prevention connects the effort to a relevant field of research, evidence-based policy and programming, and a broader population reach. This answer is reached by examining conceptual alignments between the two fields at both the case-level and the theoretical level. To address extremist violence within the wider reach of violence prevention, having a shared model is seen as a first step. The World Health Organization uses the social-ecological framework for assessing the risk and protective factors for violence and developing effective public-health based programmes. This study illustrates how this model has been used for gang violence prevention and explores overlaps between gang violence prevention and preventing violent extremism. Finally, it provides policy and programme recommendations to align CVE with public health violence prevention.

Countdown to 2015 country case studies: systematic tools to address the "black box" of health systems and policy assessment.

PubMed

Singh, Neha S; Huicho, Luis; Afnan-Holmes, Hoviyeh; John, Theopista; Moran, Allisyn C; Colbourn, Tim; Grundy, Chris; Matthews, Zoe; Maliqi, Blerta; Mathai, Matthews; Daelmans, Bernadette; Requejo, Jennifer; Lawn, Joy E

2016-09-12

Evaluating health systems and policy (HSP) change and implementation is critical in understanding reproductive, maternal, newborn and child health (RMNCH) progress within and across countries. Whilst data for health outcomes, coverage and equity have advanced in the last decade, comparable analyses of HSP changes are lacking. We present a set of novel tools developed by Countdown to 2015 (Countdown) to systematically analyse and describe HSP change for RMNCH indicators, enabling multi-country comparisons. International experts worked with eight country teams to develop HSP tools via mixed methods. These tools assess RMNCH change over time (e.g. 1990-2015) and include: (i) Policy and Programme Timeline Tool (depicting change according to level of policy); (ii) Health Policy Tracer Indicators Dashboard (showing 11 selected RMNCH policies over time); (iii) Health Systems Tracer Indicators Dashboard (showing four selected systems indicators over time); and (iv) Programme implementation assessment. To illustrate these tools, we present results from Tanzania and Peru, two of eight Countdown case studies. The Policy and Programme Timeline tool shows that Tanzania's RMNCH environment is complex, with increased funding and programmes for child survival, particularly primary-care implementation. Maternal health was prioritised since mid-1990s, yet with variable programme implementation, mainly targeting facilities. Newborn health only received attention since 2005, yet is rapidly scaling-up interventions at facility- and community-levels. Reproductive health lost momentum, with re-investment since 2010. Contrastingly, Peru moved from standalone to integrated RMNCH programme implementation, combined with multi-sectoral, anti-poverty strategies. The HSP Tracer Indicators Dashboards show that Peru has adopted nine of 11 policy tracer indicators and Tanzania has adopted seven. Peru costed national RMNCH plans pre-2000, whereas Tanzania developed a national RMNCH plan in 2006 but only costed the reproductive health component. Both countries included all lifesaving RMNCH commodities on their essential medicines lists. Peru has twice the health worker density of Tanzania (15.4 vs. 7.1/10,000 population, respectively), although both are below the 22.8 WHO minimum threshold. These are the first HSP tools using mixed methods to systematically analyse and describe RMNCH changes within and across countries, important in informing accelerated progress for ending preventable maternal, newborn and child mortality in the post-2015 era.

[Harm reduction interventions in drug users: current situation and recommendations].

PubMed

Bosque-Prous, Marina; Brugal, María Teresa

2016-11-01

Harm reduction encompasses interventions, programmes and policies that seek to reduce the negative consequences of the consumption of both legal and illegal drugs on the individual and public health. Harm reduction looks to mitigate the harm suffered by drug users through drug use monitoring and prevention, and promotes initiatives that respect and protect the human rights of this population. The harm reduction policies that have proven effective and efficient are: opioid substitution maintenance therapy (methadone); needle and syringe exchange programmes; supervised drug consumption rooms; and overdose prevention through peer-based naloxone distribution. In order to be effective, these policies must have comprehensive coverage and be implemented in areas where the target population is prevalent. Resident-based opposition to the implementation of these policies is known as the NIMBY (Not In My Back Yard) phenomenon, which is characterised by being against the implementation of new measures in a particular place, but does not question their usefulness. Given that any NIMBY phenomenon is a complex social, cultural and political phenomenon, it is important to conduct a thorough analysis of the situation prior to implementing any of these measures. Harm reduction policies must be extended to other substances such as alcohol and tobacco, as well as to other conditions beyond infectious/contagious diseases and overdose. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Building policy-making capacity in the Ministry of Health: the Kazakhstan experience.

PubMed

Chanturidze, Tata; Adams, Orvill; Tokezhanov, Bolat; Naylor, Mike; Richardson, Erica

2015-01-20

Recent economic growth in Kazakhstan has been accompanied by slower improvements in population health and this has renewed impetus for health system reform. Strengthening strategic planning and policy-making capacity in the Ministry of Health has been identified as an important priority, particularly as the Ministry of Health is leading the health system reform process. The intervention was informed by the United Nations Development Programme (UNDP) framework for capacity building which views capacity building as an ongoing process embedded in local institutions and practices. In response to local needs extra elements were included in the framework to tailor the capacity building programme according to the existing policy and budget cycles and respective competence requirements, and link it with transparent career development structures of the Ministry of Health. This aspect of the programme was informed by the institutional capability assessment model used by the United Kingdom National Health Service (NHS) which was adapted to examine the specific organizational and individual competences of the Ministry of Health in Kazakhstan. There were clear successes in building capacity for policy making and strategic planning within the Ministry of Health in Kazakhstan, including better planned, more timely and in-depth responses to policy assignments. Embedding career development as a part of this process was more challenging. This case study highlights the importance of strong political will and high level support for capacity building in ensuring the sustainability of programmes. It also shows that capacity-building programmes need to ensure full engagement with all local stakeholders, or where this is not possible, programmes need to be targeted narrowly to those stakeholders who will benefit most, for the greatest impact to be achieved. In sum, high quality tailor-made capacity development programmes should be based on thorough needs assessment of individual and organizational competences in a specific institutional setting. The experience showed that complementary approaches to human resource development worked effectively in the context of organizations and systems, where an enabling environment was present, and country ownership and political will was complemented by strong technical assistance to design and deliver high quality tailor-made capacity building initiatives.

Health promotion programme in the private workplaces in Singapore: a prevalence survey.

PubMed

Chew, L; Cheah, C; Koh, Y H

2002-01-01

A postal survey was conducted in 4,479 private companies with at least 50 employees in 1998 to determine the prevalence and the scope of workplace health promotion programme in these companies in Singapore. The self-administered questionnaire mailed to the study population covered five areas viz, organisational details, workplace health policies, health promotion and related activities, workplace health facilities and the source of assistance for the programme. The overall response was 49.5%. Parkinson's definition of workplace health promotion was used in the analysis to determine the prevalence of the programme. The data was collated on DBase IV and analysed using SPSS computer programmes. About one third of the respondents covering an estimated 26% of the private sector workforce had a comprehensive workplace health promotion programme as defined by Parkinson. This prevalence was a function of workforce size and industry type. Workplaces with larger workforce size (p<0.001) and those from the manufacturing and human/health service sectors (p<0.001) were more likely to have such programmes compared to their smaller counterparts and other industries respectively. The management remained the main driver behind these programmes. Many of the programmes were centred around health promoting policies and facilities with emphasis on occupational healthl safety and smoking issues. A significant proportion of workplaces surveyed had in place a comprehensive workplace health promotion programme. However, more could still be done to encourage its uptake such as training for facilitators, consultation, grant provision etc. Small workplaces remained an untapped market for such programmes.

Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming

PubMed Central

Ndinda, Catherine; Ndhlovu, Tidings; Khalema, Nene Ernest

2017-01-01

Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal. PMID:28350334

Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming.

PubMed

Ndinda, Catherine; Ndhlovu, Tidings; Khalema, Nene Ernest

2017-03-28

Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal.

Breast cancer in European Union: an update of screening programmes as of March 2014 (review).

PubMed

Altobelli, E; Lattanzi, A

2014-11-01

Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.

Good on paper: the gap between programme theory and real-world context in Pakistan's Community Midwife programme

PubMed Central

Mumtaz, Z; Levay, A; Bhatti, A; Salway, S

2015-01-01

Objective To understand why skilled birth attendance—an acknowledged strategy for reducing maternal deaths—has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory-driven approach to evaluating implementation of maternal healthcare interventions. Design Implementation research was conducted using an institutional ethnographic approach. Setting and population National programme and local community levels in Pakistan. Methods Observations, focus group discussions, and in-depth interviews were conducted with 38 Community Midwives (CMWs), 20 policymakers, 45 healthcare providers and 136 community members. A critical policy document review was conducted. National and local level data were brought together. Main outcomes Alignment of programme theory with real-world practice. Results Data revealed gaps between programme theory, assumptions and reality on the ground. The design of the programme failed to take into account: (1) the incongruity between the role of a midwife and dominant class and gendered norms that devalue such a role; (2) market and consumer behaviour that prevented CMWs from establishing private practices; (3) the complexity of public–private sector cooperation. Uniform deployment policies failed to consider existing provider density and geography. Conclusions Greater attention to programme theory and the ‘real-world’ setting during design of maternal health strategies is needed to achieve consistent results in different contexts. PMID:25315837

Global policy for improvement of oral health in the 21st century--implications to oral health research of World Health Assembly 2007, World Health Organization.

PubMed

Petersen, Poul Erik

2009-02-01

The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past 5 years to increase the awareness of oral health worldwide as oral health is important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and necessary actions to the continuous improvement of oral health. The strategy is that oral disease prevention and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120 and WHA60, the Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development or adjustment of oral health programmes at national level. Clinical and public health research has shown that a number of individual, professional and community preventive measures are effective in preventing most oral diseases. However, advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The WHO Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

PubMed

Schultz, J A; Collie-Akers, V L; Fawcett, S B; Strauss, W J; Nagaraja, J; Landgraf, A J; McIver, K L; Weber, S A; Arteaga, S S; Nebeling, L C; Rauzon, S M

2018-06-19

Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability. © 2018 World Obesity Federation.

Population policies, programmes and the environment

PubMed Central

Speidel, J. Joseph; Weiss, Deborah C.; Ethelston, Sally A.; Gilbert, Sarah M.

2009-01-01

Human consumption is depleting the Earth's natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least $5 billion of the total, however, current donor assistance is less than a quarter of this funding target. PMID:19770155

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT)

PubMed Central

Vallières, Frédérique; Hyland, Philip; Murphy, Jamie; Hansen, Maj; Shevlin, Mark; Elklit, Ask; Ceannt, Ruth; Armour, Cherie; Wiedemann, Nana; Munk, Mette; Dinesen, Cecilie; O’Hare, Geraldine; Cunningham, Twylla; Askerod, Ditte; Spitz, Pernille; Blackwell, Noeline; McCarthy, Angela; O’Dowd, Leonie; Scott, Shirley; Reid, Tracey; Mokake, Andreas; Halpin, Rory; Perera, Camila; Gleeson, Christina; Frost, Rachel; Flanagan, Natalie; Aldamman, Kinan; Tamrakar, Trina; Louison Vang, Maria; Sherwood, Larissa; Travers, Áine; Haahr-Pedersen, Ida; Walshe, Catherine; McDonagh, Tracey; Bramsen, Rikke Holm

2018-01-01

ABSTRACT In this paper we present a description of the Horizon2020, Marie Skłodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology. PMID:29372015

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT).

PubMed

Vallières, Frédérique; Hyland, Philip; Murphy, Jamie; Hansen, Maj; Shevlin, Mark; Elklit, Ask; Ceannt, Ruth; Armour, Cherie; Wiedemann, Nana; Munk, Mette; Dinesen, Cecilie; O'Hare, Geraldine; Cunningham, Twylla; Askerod, Ditte; Spitz, Pernille; Blackwell, Noeline; McCarthy, Angela; O'Dowd, Leonie; Scott, Shirley; Reid, Tracey; Mokake, Andreas; Halpin, Rory; Perera, Camila; Gleeson, Christina; Frost, Rachel; Flanagan, Natalie; Aldamman, Kinan; Tamrakar, Trina; Louison Vang, Maria; Sherwood, Larissa; Travers, Áine; Haahr-Pedersen, Ida; Walshe, Catherine; McDonagh, Tracey; Bramsen, Rikke Holm

2018-01-01

In this paper we present a description of the Horizon2020, Marie Skłodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

[Lifestyle interventions at work?].

PubMed

Hulshof, Carel T J

2013-01-01

So far many worksite lifestyle or health promotion programmes have shown only moderate evidence of effectiveness and cost-effectiveness. However, participation in work is in itself an important determinant of health. For this reason ensuring of fitting work and sustained workability should be an aspect of health policy. Workers' health is not only determined by their working environment but also by health practices and lifestyle factors. Under certain preconditions (e.g. on a voluntary basis, confidentiality, integration with health protection) lifestyle interventions during work time can contribute to a healthier working population. As such programmes may result in financial and social benefits for employers, they should be partly responsible for paying the costs. From a societal perspective, governmental commitment to a preventive policy and the involvement of health and income insurance companies are also required.

Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network.

PubMed

Takian, Amirhossein; Doshmangir, Leila; Rashidian, Arash

2013-10-01

The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran. We conducted a qualitative study involving 71 semi-structured interviews at national, provincial and local levels, and three focus group discussions at local level, plus a purposeful content analysis of documents of various types. We used a mixed inductive/deductive framework approach for data analysis. We identified seven main aspects related to the existing primary health network, which contributed to the implementation of FP programme: 'a respected and functioning PHC network', 'accessibility and geographical coverage', 'efficient hierarchy', 'the only possible host', 'a remedy for chronic challenges in the rural PHC', 'FP as the gatekeeper?' and 'the role of the private sector'. The existence of a functioning PHC was pivotal in driving policy makers' decision to implement FP programme. Implementing a new policy depends on its hosting context. In regards to FP programme and rural insurance in Iran, the existing PHC network proved to be a fundamental asset in facilitating the implementation of FP programme in rural areas.

Nature and impact of European anti-stigma depression programmes.

PubMed

Quinn, Neil; Knifton, Lee; Goldie, Isabella; van Bortel, Tine; Dowds, Julie; Lasalvia, Antonio; Scheerder, Gert; Boumans, Jenny; Svab, Vesna; Lanfredi, Mariangela; Wahlbeck, Kristian; Thornicroft, Graham

2014-09-01

Stigma associated with depression is a major public health issue in the EU, with over 20 million people experiencing depression and its associated personal distress each year. While most programmes against stigma related to mental health problems are of a general nature, the knowledge about programmes tackling stigma against people with depression is limited. This study therefore aims to assess the nature and impact of depression-specific programmes in EU countries. Using a web-based tool, 26 programmes were identified across the 18 EU countries taking part in the study. Most were universal and targeted the whole population, while many also targeted specific population groups or settings, such as young people or health professionals. The most common programme aim was improving literacy, although reducing stigmatizing attitudes and discriminatory behaviour and promoting help-seeking were also common. Most programmes originated from professional bodies, or as grassroots initiatives from service user groups/NGOs, rather than as part of national and local policy. The approaches used were primarily different forms of education/information, with some, but very limited, use of positive personal contact. Overall, the quality and extent of impact of the programmes was limited, with few leading to peer-reviewed publications. Specific programmes were identified with evidence of positive impact, and we drew on these examples to develop a framework to be used for future programmes against stigma and discrimination associated with depression. These findings are provided in full in the Anti-Stigma Partnership European Network Toolkit available at www.antistigma.eu. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Breastfeeding promotion, support and protection: review of six country programmes.

PubMed

Mangasaryan, Nune; Martin, Luann; Brownlee, Ann; Ogunlade, Adebayo; Rudert, Christiane; Cai, Xiaodong

2012-08-01

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a "health equalizer" and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers' training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages.

Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland.

PubMed

Sharp, Linda; Tilson, Lesley; Whyte, Sophie; Ceilleachair, Alan O; Walsh, Cathal; Usher, Cara; Tappenden, Paul; Chilcott, James; Staines, Anthony; Barry, Michael; Comber, Harry

2013-03-19

Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55-74 years, and (c) biennial faecal immunochemical tests (FIT) at 55-74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55-64 years) and staggered age-based roll-out across the 55-74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55-74). FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381-1,053 with FSIG-based, and 967-1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning.

Nutrition advocacy and national development: the PROFILES programme and its application.

PubMed

Burkhalter, B R; Abel, E; Aguayo, V; Diene, S M; Parlato, M B; Ross, J S

1999-01-01

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies.

Overcoming access barriers to health services through membership-based microfinance organizations: a review of evidence from South Asia

PubMed Central

Saha, Somen; Annear, Peter Leslie

2015-01-01

It is a challenge for the poor to overcome the barriers to accessing health services. Membership-based microfinance with associated health programmes can improve health outcomes for the poor. This study reviewed the evidence published between 1993 and 2013 on the role of membership-based microfinance with associated health programmes in improving health outcomes for the poor in South Asia. A total of 661 papers were identified and 26 selected for inclusion, based on the relevance and rigour of the research methods. Of these 26, five were evidence reviews. Of the remaining 21 papers, 12 were from India, seven from Bangladesh, and one each from Sri Lanka and Indonesia. Three papers addressed more than one theme. Five key themes emerged from the review: (i) the impact of microfinance programmes on the social and economic situation of the poor; (ii) the impact of microfinance programmes on community health; (iii) the impact of integrated microfinance health programmes on raising client awareness; (iv) the impact of integrated microfinance health programmes on financing health care; and (v) the impact of integrated microfinance health programmes on affordable health-care products and services. The review provides new evidence on the pathways through which microfinance helps to improve population health and value for money for such programmes. Among countries with large populations in the informal sector, there is a strong case for policy-makers to support these groups in providing access to life-saving health care among the poor. PMID:25685728

Searching for sustainability within public health policy: insights from an injury prevention perspective.

PubMed

Errington, Gail; Evans, Catrin; Watson, Michael C

2017-04-01

Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Vocational Education and Training in India: A Labour Market Perspective

ERIC Educational Resources Information Center

Agrawal, Tushar; Agrawal, Ankush

2017-01-01

Skill development has been a major policy agenda in several countries and there is a lot of emphasis on the promotion of vocational education and training (VET) programmes. This paper investigates the labour market outcomes of the vocationally trained population in India using the data from a nationally representative survey on employment and…

Ageing, Learning and Health: Making Connections

ERIC Educational Resources Information Center

Mestheneos, Elizabeth; Withnall, Alexandra

2016-01-01

The health of ageing populations is a real concern across the world so that the concept of active ageing has been advocated as a framework for appropriate educational policies and programmes to support people as they grow older. The other elements discussed here are health and healthy life expectancy (HLE) acknowledging that as people age, they…

Prevention of mental and behavioural disorders: implications for policy and practice.

PubMed

Saxena, Shekhar; Jané-Llopis, Eva; Hosman, Clemens

2006-02-01

There is sufficient evidence indicating the efficacy of interventions in reducing risk factors, increasing protective factors, preventing psychiatric symptoms and new cases of mental disorders. Macro-policy interventions to improve nutrition, housing and education or to reduce economic insecurity have proven to reduce mental health problems. Specific interventions to increase resilience in children and adolescents through parenting and early interventions, and programmes for children at risk for mental disorders such as those who have a mentally ill parent or have suffered parental loss or family disruption, have also shown to increase mental well-being and decrease depressive symptoms and the onset of depressive disorders. Interventions for the adult population, from macro-policy strategies, such as taxation of alcohol products or workplace legislation, to individual support for those with signs of a mental disorder, can reduce mental health problems and associated social and economic burdens. Exercise, social support or community participation have also shown to improve mental health of older populations. Public mental health will benefit from continuing building the evidence base through combining different evaluation methods across low, middle and high income countries. The translation of evidence into policy and practice calls for action at the international, national and local level, including building capacity, advocacy, mainstreaming mental health into public health and other policies and securing infrastructures and sustainability. Mental health professionals have an important role to play in improving the evidence on prevention and promotion in mental health, in engaging relevant stakeholders for developing programmes, and as professional care providers in their practice.

Prevention of mental and behavioural disorders: implications for policy and practice

PubMed Central

SAXENA, SHEKHAR; JANÉ-LLOPIS, EVA; HOSMAN, CLEMENS

2006-01-01

There is sufficient evidence indicating the efficacy of interventions in reducing risk factors, increasing protective factors, preventing psychiatric symptoms and new cases of mental disorders. Macro-policy interventions to improve nutrition, housing and education or to reduce economic insecurity have proven to reduce mental health problems. Specific interventions to increase resilience in children and adolescents through parenting and early interventions, and programmes for children at risk for mental disorders such as those who have a mentally ill parent or have suffered parental loss or family disruption, have also shown to increase mental well-being and decrease depressive symptoms and the onset of depressive disorders. Interventions for the adult population, from macro-policy strategies, such as taxation of alcohol products or workplace legislation, to individual support for those with signs of a mental disorder, can reduce mental health problems and associated social and economic burdens. Exercise, social support or community participation have also shown to improve mental health of older populations. Public mental health will benefit from continuing building the evidence base through combining different evaluation methods across low, middle and high income countries. The translation of evidence into policy and practice calls for action at the international, national and local level, including building capacity, advocacy, mainstreaming mental health into public health and other policies and securing infrastructures and sustainability. Mental health professionals have an important role to play in improving the evidence on prevention and promotion in mental health, in engaging relevant stakeholders for developing programmes, and as professional care providers in their practice. PMID:16757984

Global health diplomacy, 'smart power', and the new world order.

PubMed

Kevany, Sebastian

2014-01-01

Both the theory and practice of foreign policy and diplomacy, including systems of hard and soft power, are undergoing paradigm shifts, with an increasing number of innovative actors and strategies contributing to international relations outcomes in the 'New World Order'. Concurrently, global health programmes continue to ascend the political spectrum in scale, scope and influence. This concatenation of circumstances has demanded a re-examination of the existing and potential effectiveness of global health programmes in the 'smart power' context, based on adherence to a range of design, implementation and assessment criteria, which may simultaneously optimise their humanitarian, foreign policy and diplomatic effectiveness. A synthesis of contemporary characteristics of 'global health diplomacy' and 'global health as foreign policy', grouped by common themes and generated in the context of related field experiences, are presented in the form of 'Top Ten' criteria lists for optimising both diplomatic and foreign policy effectiveness of global health programmes, and criteria are presented in concert with an examination of implications for programme design and delivery. Key criteria for global health programmes that are sensitised to both diplomatic and foreign policy goals include visibility, sustainability, geostrategic considerations, accountability, effectiveness and alignment with broader policy objectives. Though diplomacy is a component of foreign policy, criteria for 'diplomatically-sensitised' versus 'foreign policy-sensitised' global health programmes were not always consistent, and were occasionally in conflict, with each other. The desirability of making diplomatic and foreign policy criteria explicit, rather than implicit, in the context of global health programme design, delivery and evaluation are reflected in the identified implications for (1) international security, (2) programme evaluation, (3) funding and resource allocation decisions, (4) approval systems and (5) training. On this basis, global health programmes are shown to provide a valuable, yet underutilised, tool for diplomacy and foreign policy purposes, including their role in the pursuit of benign international influence. A corresponding alignment of resources between 'hard' and 'smart' power options is encouraged.

'The one with the purse makes policy': Power, problem definition, framing and maternal health policies and programmes evolution in national level institutionalised policy making processes in Ghana.

PubMed

Koduah, Augustina; Agyepong, Irene Akua; van Dijk, Han

2016-10-01

This paper seeks to advance our understanding of health policy agenda setting and formulation processes in a lower middle income country, Ghana, by exploring how and why maternal health policies and programmes appeared and evolved on the health sector programme of work agenda between 2002 and 2012. We theorized that the appearance of a policy or programme on the agenda and its fate within the programme of work is predominately influenced by how national level decision makers use their sources of power to define maternal health problems and frame their policy narratives. National level decision makers used their power sources as negotiation tools to frame maternal health issues and design maternal health policies and programmes within the framework of the national health sector programme of work. The power sources identified included legal and structural authority; access to authority by way of political influence; control over and access to resources (mainly financial); access to evidence in the form of health sector performance reviews and demographic health surveys; and knowledge of national plans such as Ghana Poverty Reduction Strategy. Understanding of power sources and their use as negotiation tools in policy development should not be ignored in the pursuit of transformative change and sustained improvement in health systems in low- and middle income countries (LMIC). Copyright © 2016 Elsevier Ltd. All rights reserved.

European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document.

PubMed

Arbyn, M; Anttila, A; Jordan, J; Ronco, G; Schenck, U; Segnan, N; Wiener, H; Herbert, A; von Karsa, L

2010-03-01

European Guidelines for Quality Assurance in Cervical Cancer Screening have been initiated in the Europe Against Cancer Programme. The first edition established the principles of organised population-based screening and stimulated numerous pilot projects. The second multidisciplinary edition was published in 2008 and comprises approximately 250 pages divided into seven chapters prepared by 48 authors and contributors. Considerable attention has been devoted to organised, population-based programme policies which minimise adverse effects and maximise benefits of screening. It is hoped that this expanded guidelines edition will have a greater impact on countries in which screening programmes are still lacking and in which opportunistic screening has been preferred in the past. Other methodological aspects such as future prospects of human papillomavirus testing and vaccination in cervical cancer control have also been examined in the second edition; recommendations for integration of the latter technologies into European guidelines are currently under development in a related project supported by the European Union Health Programme. An overview of the fundamental points and principles that should support any quality-assured screening programme and key performance indicators are presented here in a summary document of the second guidelines edition in order to make these principles and standards known to a wider scientific community.

Pakistan mental health country profile.

PubMed

Karim, Salman; Saeed, Khalid; Rana, Mowaddat Hussain; Mubbashar, Malik Hussain; Jenkins, Rachel

2004-01-01

The Republic of Pakistan is a South East Asian country with a population of over 140.7 million. Its population is fast growing and the majority (70%) live in rural areas with a feudal or tribal value system. The economy is dependent on agriculture and 35% of the population live below the poverty line. Islam is the main religion and 'mental illnesses' are stigmatized and widely perceived to have supernatural causes. The traditional healers along with psychiatric services are the main mental health service providers. The number of trained mental health professionals is small as compared to the population demands and specialist services are virtually non-existent. Lack of data on prevalence of various mental illnesses and monitory constraints are the major hurdles in the development of mental health services. A number of innovative programmes to develop indigenous models of care like the 'Community Mental Health Programme' and 'Schools Mental Health Programme' have been developed. These programmes have been found effective in reducing stigma and increase awareness of mental illness amongst the adults and children living in rural areas. Efforts by the government and mental health professionals have led to the implementation of a 'National Mental Health Policy' and 'Mental Health Act' in 2001. These aim at integrating mental health services with the existing health services, improving mental health care delivery and safeguarding the rights of mentally ill people. A favourable political will and the help of international institutions like the World Health Organization are required to achieve these aims.

Policy options for increasing the supply of transplantable kidneys in Singapore

PubMed Central

Chong, Jia Loon

2016-01-01

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered. PMID:27779281

Roma Mediators in Europe: A New Council of Europe Programme

ERIC Educational Resources Information Center

Kyuchukov, Hristo

2012-01-01

In several European countries the number of the Roma represents approximately 10% of the total population. Due to the global economic crisis, the rise of the far right in places like Hungary, and failed policies of the past, their present social and economic situation continues to become more vulnerable. Mediation is one of the measures used…

The World Health Organization-United Nations Population Fund Strategic Partnership Programme's implementation of family planning guidelines and tools in Asia-Pacific countries.

PubMed

Mody, Sheila K; Ba-Thike, Katherine; Gaffield, Mary E

2013-04-01

The aim of this study was to assess the impact of the Strategic Partnership Programme, a collaboration between the World Health Organization and the United Nations Population Fund to improve evidence-based guidance for country programs through the introduction of selected practice guidelines to improve sexual and reproductive health. Information for this report is from questionnaires sent to Ministries of Health in 2004 (baseline assessment) and in 2007 (assessment of outcome), annual country reports and personal communication with focal points from Ministries of Health and World Health Organization regional and country offices. Following the Strategic Partnership Programme, family planning guidance was used extensively to: formulate and update reproductive health policy; update standards and guidelines; improve training curricula; conduct training activities; develop advocacy and communication materials; and promote change in service. The Strategic Partnership Programme was successful in promoting the introduction of evidence-based guidelines for reproductive health in several Asian countries. The countries that adapted the family planning guidance observed an increase in demand for contraceptives commodities. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

An integration programme of poverty alleviation and development with family planning.

PubMed

1997-04-01

The State Council (the central government) recently issued a Circular for Speeding Up the Integration of Poverty Alleviation and Development with the Family Planning Programme during the Ninth Five-year Plan (1996-2000). The Circular was jointly submitted by the State Family Planning Commission and the Leading Group for Poverty Alleviation and Development. The document sets the two major tasks as solving the basic needs for food and clothing of the rural destitute and the control of over-rapid growth of China's population. Practice indicates that a close Integration Programme is the best way for impoverished farmers to alleviate poverty and become better-off. Overpopulation and low educational attainments and poor health quality of population in backward areas are the major factors retarding socioeconomic development. Therefore, it is inevitable to integrate poverty alleviation with family planning. It is a path with Chinese characteristics for a balanced population and sustainable socioeconomic development. The targets of the Integration Programme are as follows: The first is that preferential policies should be worked out to guarantee family planning acceptors, especially households with an only daughter or two daughters, are the first to be helped to eradicate poverty and become well-off. They should become good examples for other rural poor in practicing fewer but healthier births, and generating family income. The second target is that the population plans for the poor counties identified by the central government and provincial governments must be fulfilled. This should contribute to breaking the vicious circle of poverty leading to more children, in turn generating more poverty. The circular demands that more efforts should focus on the training of cadres for the Integrated Programme and on services for poor family planning acceptors. full text

Nutrition advocacy and national development: the PROFILES programme and its application.

PubMed Central

Burkhalter, B. R.; Abel, E.; Aguayo, V.; Diene, S. M.; Parlato, M. B.; Ross, J. S.

1999-01-01

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies. PMID:10361758

Breastfeeding Promotion, Support and Protection: Review of Six Country Programmes

PubMed Central

Mangasaryan, Nune; Martin, Luann; Brownlee, Ann; Ogunlade, Adebayo; Rudert, Christiane; Cai, Xiaodong

2012-01-01

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages. PMID:23016128

Nutrition transition in Bangladesh: is the country ready for this double burden.

PubMed

Khan, Shusmita Hossain; Talukder, Shamim Hayder

2013-11-01

Malnutrition has dominated Bangladesh development, encouraged by the Bangladesh Integrated Nutrition Programme under the first Sector-Wide Approach (SWAp) World Health Organization, and the United Nations Food and Agriculture Organization. To date, all the SWAps for health, nutrition and population well-being have identified malnutrition as a priority. Donors, United Nations organizations and non-governmental organizations provide extensive support to prevent and tackle malnutrition in the country. The government has delineated an effective policy response to the high prevalence of undernutrition. Bangladesh has a wide range of policies encouraging appropriate infant and young child feeding practices, 6 months of paid maternity leave in the public sector, school meals for vulnerable communities, micronutrient supplementation interventions and more. However, almost all of these efforts address the undernutrition aspect of malnutrition, neglecting the other form of malnutrition - overnutrition. Trend data from national surveys show steady increases in overweight and steady decreases in underweight among women of reproductive age. This paper sheds light on the trend data, showing the transition from under- to overnutrition and the double burden of malnutrition among Bangladeshi women of reproductive age. It also discusses the national policy and programme responses to overweight and obesity in Bangladesh among the same population. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland

PubMed Central

2013-01-01

Background Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning. PMID:23510135

The Rise and Fall of Workplace Basic Skills Programmes: Lessons for Policy and Practice

ERIC Educational Resources Information Center

Wolf, Alison; Aspin, Liam; Waite, Edmund; Ananiadou, Katerina

2010-01-01

Since the publication of the Moser Report in 1999, improving the basic skills of adults has been a major priority for all of the UK's governments. There has been a particular interest in building up workplace provision, because of the assumed relationship between the basic skills of the employed population and productivity. A longitudinal study…

Active Agents of Health Promotion? The School's Role in Supporting the HPV Vaccination Programme

ERIC Educational Resources Information Center

Spratt, Jennifer; Shucksmith, Janet; Philip, Kate; McNaughton, Rebekah

2013-01-01

By providing a place in which children can be accessed, the school has long been a site for population-level health initiatives. Recent policy shifts towards health-promoting schools have however re-cast the school from passive host to active collaborator in public health. This paper examines secondary school teachers' views of their roles as…

Recolonising Debates or Perpetuated Coloniality? Decentring the Spaces of Disability, Development and Community in the Global South

ERIC Educational Resources Information Center

Grech, Shaun

2011-01-01

The World Health Organisation estimates that around 600 million people or 10% of the world's population is disabled, with more than 80% concentrated in the global South. In spite of this, majority world disability remains stranded on the peripheries of development policy, research and programmes, and virtually excluded from the Western-centric…

XVII International AIDS Conference: From Evidence to Action - Regional focus

PubMed Central

2009-01-01

This article summarizes the challenges, opportunities and lessons learned from presentations, discussions and debates addressing major policy and programmatic responses to HIV in six geographical regions: Sub-Saharan Africa, Asia and the Pacific, Eastern Europe and Central Asia, Latin America, Caribbean, and Middle East and North Africa. It draws from AIDS 2008 Leadership and Community Programmes, particularly the six regional sessions, and Global Village activities. While the epidemiological, cultural and socio-economic contexts in these regions vary considerably, several common, overarching principles and themes emerged. They include: advancing basic human rights, particularly for vulnerable and most at risk populations; ensuring the sustainability of the HIV response through long-term, predictable financing; strengthening health systems; investing in strategic health information; and improving accountability and the involvement of civil society in the response to AIDS. Equally important is the need to address political barriers to implementing evidence-based interventions such as opioid substitution therapy (OST), needle and syringe programmes (NSPs), comprehensive sexuality education for youth, and sexual and reproductive rights. Finally, these regional discussions emphasized the need for legislative and policy reforms related to structural barriers facing women and girls, MSM, IDUs, sex workers and migrant populations. PMID:19811672

A training programme to build cancer research capacity in low- and middle-income countries: findings from Guatemala.

PubMed

Arnold, Lauren D; Barnoya, Joaquin; Gharzouzi, Eduardo N; Benson, Peter; Colditz, Graham A

2014-04-01

Guatemala is experiencing an increasing burden of cancer but lacks capacity for cancer prevention, control and research. In partnership with a medical school in the United States of America, a multidisciplinary Cancer Control Research Training Institute was developed at the Instituto de Cancerología (INCAN) in Guatemala City. This institute provided a year-long training programme for clinicians that focused on research methods in population health and sociocultural anthropology. The programme included didactic experiences in Guatemala and the United States as well as applied training in which participants developed research protocols responsive to Guatemala's cancer needs. Although INCAN is the point of referral and service for Guatemala's cancer patients, the institute's administration is also interested in increasing cancer research - with a focus on population health. INCAN is thus a resource for capacity building within the context of cancer prevention and control. Trainees increased their self-efficacy for the design and conduct of research. Value-added benefits included establishment of an annual cancer seminar and workshops in cancer pathology and qualitative analysis. INCAN has recently incorporated some of the programme's components into its residency training and established a research department. A training programme for clinicians can build cancer research capacity in low- and middle-income countries. Training in population-based research methods will enable countries such as Guatemala to gather country-specific data. Once collected, such data can be used to assess the burden of cancer-related disease, guide policy for reducing it and identify priority areas for cancer prevention and treatment.

What was the programme theory of New Labour's Health System Reforms?

PubMed

Millar, Ross; Powell, Martin; Dixon, Anna

2012-01-01

To examine whether the Health System Reforms delivered the promise of being a coherent and mutually supporting reform programme; to identify the underlying programme theory of the reform programme; to reflect on whether lessons have been learned. Documentary analysis mapping the implicit and explicit programme theories about how the reforms intended to achieve its goals and outcomes. Semi-structured interviews with policy-makers to further understand the programme theory. The Health System Reforms assumed a 'one size fits all' approach to policy implementation with little recognition that some contexts can be more receptive than others. There was evidence of some policy evolution and rebalancing between the reform streams as policy-makers became aware of some perverse incentives and unforeseen consequences. Later elements aimed to restore balance to the system. The Health System Reforms do not appear to comprise a coherent and mutually supportive set of levers and incentives. They appear unbalanced with the centre of gravity favouring suppliers over commissioners. However, recent reform changes have sought to redress this imbalance to some extent, suggesting that lessons have been learned and policies have been adapted over time.

Population and women in development: gender issues in the context of population and development.

PubMed

Eshete, A

1992-12-01

"The objective of this paper is to examine women's productive and reproductive roles and their intricate linkages and the interplay with the demographic variables of population and development. Although these interactions...are not yet fully understood, attempts will be made utilizing available data and literature to make an analysis of the linkages and interplays that exist between population variables with factors associated with the role, status and participation of women in the social and economic lives of African societies.... The paper will analyze the linkages and integrate the implications for population policies and programmes towards the enhancement of women's role and status and their participation in the development process." excerpt

Tobacco control approaches and inequity--how far have we come and where are we going?

PubMed

Purcell, Kate R; O'Rourke, Kerryn; Rivis, Maya

2015-09-01

Despite Australia's success in reducing smoking rates, substantial inequities persist--with high smoking prevalence among disadvantaged groups. This article uses Fair Foundations: The VicHealth framework for health equity to identify promising strategies for promoting equity within tobacco control policies and programmes. A rapid review of the Australian and international literature was conducted in March 2014 using Pubmed, ISI web of Science and Scopus, Cochrane library and Google Scholar. A search of the grey literature was conducted to identify promising policy interventions. Population health surveys suggest that tobacco-related inequities in Victoria are beginning to decline. Data from the Victorian Smoking Survey shows that the inequity gap is narrowing, and in recent years, the prevalence of regular smoking declined fastest among disadvantaged smokers. Future approaches to accelerate reductions in tobacco-related inequities include: (i) continue proven population-based tobacco control policies--especially increasing the price of tobacco (while remaining cognisant of the increased economic burden for those smokers who do not quit), and continuing mass media campaigns; (ii) strengthening social policies to promote equity in early child development; educational experiences; quality of local environments; employment and working conditions; (iii) identifying and investing in targeted approaches to influence social norms and more effectively identify and support disadvantaged smokers to quit; (iv) within tobacco control programmes, give greatest priority to interventions focused on adult smokers (including pregnant women and their partners). © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Do selective immunisation against tuberculosis and hepatitis B reach the targeted populations? A nationwide register-based study evaluating the recommendations in the Norwegian Childhood Immunisation Programme.

PubMed

Feiring, Berit; Laake, Ida; Molden, Tor; Håberg, Siri E; Nøkleby, Hanne; Seterelv, Siri Schøyen; Magnus, Per; Trogstad, Lill

2016-04-12

Selective immunisation is an alternative to universal vaccination if children at increased risk of disease can be identified. Within the Norwegian Childhood Immunisation Programme, BCG vaccine against tuberculosis and vaccine against hepatitis B virus (HBV) are offered only to children with parents from countries with high burden of the respective disease. We wanted to study whether this selective immunisation policy reaches the targeted groups. The study population was identified through the Norwegian Central Population Registry and consisted of all children born in Norway 2007-2010 and residing in Norway until their second birthday, in total 240,484 children. Information on vaccinations from the Norwegian Immunisation Registry, and on parental country of birth from Statistics Norway, was linked to the population registry by personal identifiers. The coverage of BCG and HBV vaccine was compared with the coverage of vaccines in the universal programme. Among the study population, 16.1% and 15.9% belonged to the target groups for BCG and HBV vaccine, respectively. Among children in the BCG target group the BCG vaccine coverage was lower than the coverage of pertussis and measles vaccine (83.6% vs. 98.6% and 92.3%, respectively). Likewise, the HBV vaccine coverage was lower than the coverage of pertussis and measles vaccine in the HBV target group (90.0% vs. 98.6% and 92.3%, respectively). The coverage of the targeted vaccines was highest among children with parents from South Asia and Sub-Saharan Africa. The coverage of vaccines in the universal programme was similar in targeted and non-targeted groups. Children targeted by selective vaccination had lower coverage of the target vaccines than of vaccines in the universal programme, indicating that selective vaccination is challenging. Improved routines for identifying eligible children and delivering the target vaccines are needed. Universal vaccination of all children with these vaccines could be considered. Copyright © 2016 Elsevier Ltd. All rights reserved.

Policy options for increasing the supply of transplantable kidneys in Singapore.

PubMed

Chong, Jia Loon

2016-10-01

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered. Copyright: © Singapore Medical Association.

Condom use in China: prevalence, policies, issues and barriers.

PubMed

Zou, Huachun; Xue, Hui; Wang, Xiaofang; Lu, Damien

2012-03-01

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.

Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt’s hepatocellular cancer epidemic: simulation of alternatives

PubMed Central

Ma, Wenkang; Soliman, Amr S; Anwar, Wagida A; Hablas, Ahmed; El Din, Tamer B; Ramadan, Mohamed; Seifeldin, Ibrahim A; Wilson, Mark L

2018-01-01

Background Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC. Methods A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the ‘new’ and ‘old’ scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15–59 years in 2008, healthy people aged 5–59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed. Results Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050. Discussion By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt’s HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention. PMID:29707244

Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt's hepatocellular cancer epidemic: simulation of alternatives.

PubMed

Ma, Wenkang; Soliman, Amr S; Anwar, Wagida A; Hablas, Ahmed; El Din, Tamer B; Ramadan, Mohamed; Seifeldin, Ibrahim A; Wilson, Mark L

2018-01-01

Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC. A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the 'new' and 'old' scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15-59 years in 2008, healthy people aged 5-59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed. Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050. By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt's HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention.

Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy.

PubMed

Angus, Colin; Scafato, Emanuele; Ghirini, Silvia; Torbica, Aleksandra; Ferre, Francesca; Struzzo, Pierluigi; Purshouse, Robin; Brennan, Alan

2014-02-06

As alcohol-related health problems continue to rise, the attention of policy-makers is increasingly turning to Screening and Brief Intervention (SBI) programmes. The effectiveness of such programmes in primary healthcare is well evidenced, but very few cost-effectiveness analyses have been conducted and none which specifically consider the Italian context. The Sheffield Alcohol Policy Model has been used to model the cost-effectiveness of government pricing and public health policies in several countries including England. This study adapts the model using Italian data to evaluate a programme of screening and brief interventions in Italy. Results are reported as Incremental Cost-Effectiveness Ratios (ICERs) of SBI programmes versus a 'do-nothing' scenario. Model results show such programmes to be highly cost-effective, with estimated ICERs of €550/Quality Adjusted Life Year (QALY) gained for a programme of SBI at next GP registration and €590/QALY for SBI at next GP consultation. A range of sensitivity analyses suggest these results are robust under all but the most pessimistic assumptions. This study provides strong support for the promotion of a policy of screening and brief interventions throughout Italy, although policy makers should be aware of the resource implications of different implementation options.

Health governance by collaboration: a case study on an area-based programme to tackle health inequalities in the Dutch city of the Hague.

PubMed

Plochg, Thomas; Schmidt, Melanie; Klazinga, Niek S; Stronks, Karien

2013-12-01

Area-based programmes are seen as a promising strategy for tackling health inequalities. In these programmes, local authorities and other local actors collaborate to employ health promoting interventions and policies. Little is known about the underlying processes of collaborative governance. To unravel this black box, we explored how the authority of The Hague, The Netherlands, developed a programme tackling health inequalities drawing on a collaborative mode of governance. Case study drawing on qualitative semi-structured interviews and document review. Data were inductively analysed against the concept of collaborative governance. The authority's ambition was to co-produce a programme on tackling health inequalities with local actors. Three stages could be distinguished in the governing process: (i) formulating policy objectives, (ii) translating policy objectives into interventions and (iii) executing health interventions. In the stage of formulating policy objectives, the collaboration led to a reframing of the initial objectives. Furthermore, the translation of the policy objectives into health interventions was rather pragmatic and loosely based on health needs and/or evidence. As a result, the concrete actions that ensued from the programme did not necessarily reflect the initial objectives. In a local system of health governance by collaboration, factors other than the stated policy objectives played a role, eventually undermining the effectiveness of the programme in reducing health inequalities. To be effective, the processes of collaborative governance underlying area-based programmes require the attention of the local authority, including the building and governing of networks, a competent public health workforce and supportive infrastructures.

[Sexual and reproductive health in Roma women: the family planning programme of Polígono Sur in Seville (Spain)].

PubMed

Escobar-Ballesta, Marta; García-Ramírez, Manuel; Albar-Marín, M ª Jesús; Paloma, Virginia

2018-04-05

To describe the challenges, resources and strategies of the staff of the family planning programme of the Polígono Sur Healthcare Centre in Seville (Spain) in their care of Roma women. This is a descriptive study in which in-depth interviews and discussion groups were held with all programme professionals, including a documentary review of the programme. The information was analyzed based on the Roma Health Integration Policy Index, a tool that evaluates the entitlement, accessibility, sensitivity and capacity for change of health programmes for the Roma population. The professionals encountered multiple challenges to implement the family planning programme with Roma women due to the characteristics of the users and the low sensitivity of the programme towards them. The absence of specific actions for Roma women within the family planning programme, agreed to by the healthcare district, obliges professionals to develop adaptations and strategies to ensure quality sexual and reproductive health services for their users. It is necessary to adapt sexual and reproductive health programmes targeted at Roma women by (a) detecting, evaluating, systematizing and disseminating good practices, (b) developing actions that address the multiple vulnerabilities of Roma women, (c) acknowledging professionals who advocate for the health of these women within their organizations, and (d) promoting reproductive justice as the goal of these programmes. Copyright © 2018 SESPAS. All rights reserved.

Ageing and Skills: A Review and Analysis of Skill Gain and Skill Loss over the Lifespan and over Time. OECD Education Working Papers, No. 72

ERIC Educational Resources Information Center

Desjardins, Richard; Warnke, Arne Jonas

2012-01-01

The relationship between ageing and skills is becoming an important policy issue, not least in the context of population ageing. Data from the Programme for the International Assessment of Adult Competencies (PIAAC) will potentially add considerably to the understanding of the relationship between ageing and foundation skills. In particular, the…

An Examination of Critical Problems Associated with the Implementation of the Universal Basic Education (UBE) Programme in Nigeria

ERIC Educational Resources Information Center

Ejere, Emmanuel Iriemi

2011-01-01

It is hardly debatable that implementation is the bane of public policies and programmes in Nigeria. A well formulated policy or programme is useless if not properly implemented as its stated objectives will not be realized. The Universal Basic Education (UBE) programme was introduced in Nigeria in September 1999 by the Obasanjo's administration.…

HIV-Stigma in Nigeria: Review of Research Studies, Policies, and Programmes

PubMed Central

Odimegwu, Clifford O.; Alabi, Olatunji O.

2017-01-01

Nigeria has about 3.8 million people living with HIV, the second largest globally. Stigma and discrimination are major barriers to testing, treatment uptake, and adherence. In this review, we synthesized information on research studies, policies, and programmes related to HIV-stigma in Nigeria. This was with a view to identify critical areas that research and programmes must address in order to accelerate the progress towards zero (new infections, discrimination, and death) target by year 2030. Existing studies were mostly devoted to stigma assessment using varieties of measures. Research, policies, and programmes in the past two decades have made very useful contributions to stigma reduction. We identified the need for a consistent, valid, and objective measure of stigma at different levels of the HIV response. Nigeria does not lack relevant policies; what needs to be strengthened are design, planning, implementation, monitoring, and evaluation of context-specific stigma reduction programmes. PMID:29445545

How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps.

PubMed

Hartmann, Miriam; Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni

2016-01-01

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994-2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations.

How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps

PubMed Central

Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni

2016-01-01

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994–2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations. PMID:28002440

Improving cancer control in the European Union: conclusions from the Lisbon round-table under the Portuguese EU Presidency, 2007.

PubMed

Gouveia, Joaquim; Coleman, Michel P; Haward, Robert; Zanetti, Roberto; Hakama, Matti; Borras, Josep Maria; Primic-Zakelj, Maja; de Koning, Harry J; Travado, Luzia

2008-07-01

Cancer is a major cause of morbidity and mortality in the European Union (EU), and a public health burden. Improving cancer control in the EU will require implementation of efficient strategies within Member States and better policy coordination between them. In cooperation between the rotating EU Presidencies of Germany (2007), Portugal (2007) and Slovenia (2008), special attention was devoted to an integrated approach to cancer control in EU policies and programmes. A round-table focussed on national cancer plans, population-based cancer registries and cancer screening programmes was held during the Health Strategies in Europe meeting in Lisbon in July 2007, under the Portuguese Presidency. These three topics were selected as critical for improving cancer control at both national and European levels. The round-table was designed to produce a set of recommendations to inform EU cancer policy. This paper provides a résumé of the conclusions and recommendations, to stimulate wider discussion and policy development. The conclusions of the meeting were presented at the Employment, Social Policy, Health and Consumer Affairs Council in December 2007 and cancer was included in the Council Conclusions for the new European Health Strategy. Success in cancer control will require consistent attention from future EU Presidencies, such as the initiative of the Slovenian EU Presidency in early 2008.

An evaluation of National Health Service England's Care Maker Programme: A mixed-methods analysis.

PubMed

Zubairu, Kate; Christiansen, Angela; Kirkcaldy, Andrew; Kirton, Jennifer A; Kelly, Carol A; Simpson, Paul; Gillespie, Andrea; Brown, Jeremy M

2017-12-01

To investigate the impact and sustainability of the Care Maker programme across England from the perspective of those involved in its delivery. The Care Maker programme was launched in England in 2013. It aims to support the "Compassion in Practice" strategy, with particular emphasis on the 6Cs of care, compassion, competence, communication, courage and commitment. Care Makers were recruited in an ambassadorial role. The intention was to inspire individuals throughout the National Health Service in England to bridge national policy with those delivering care. A mixed methods design was chosen, but this article focuses on two of the four distinct empirical data collection phases undertaken as part of this evaluation: a questionnaire with Care Makers; and two case studies of separate National Health Service trust sites. Data were collected for this evaluation in 2015. An online questionnaire was distributed to the total population of Care Makers across the National Health Service in England. It included a combination of open and closed questions. The case studies involved semistructured telephone interviews with a range of professionals engaged with the Care Maker programme across the trust sites. Care Makers reported that participation in the programme had offered opportunities in terms of improving the quality-of-care provision in the workplace as well as contributing towards their own professional development. The Care Maker programme has supported and helped underpin the nursing, midwifery and care strategy "Compassion in Practice". This model of using volunteers to embed strategy and policy could potentially be used in other areas of clinical practice and indeed in other countries. © 2017 John Wiley & Sons Ltd.

The role of SEA in integrating and balancing high policy objectives in European cohesion funding programmes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiricka, Alexandra, E-mail: alexandra.jiricka@boku.ac.at; Proebstl, Ulrike, E-mail: ulrike.proebstl@boku.ac.at

Funding programmes for European cohesion policy are a crucial tool to support the sustainability goals of the European Union and national policies of its member states. All these funding programmes require a Strategic Environmental Assessment (SEA) to enhance sustainable development. This article compares five first SEA applications at cohesion policy level to discuss challenges, limitations and benefits of this instrument. In order to support the SEA-process a 'Handbook on SEA for Cohesion Policy 2007-13' (GRDP 2006) was developed. The paper examines the special requirements and challenges at the programme level given the special conditions for stakeholder involvement, integration of SEAmore » in the programme development process and strategies to cope with uncertainties to ensure real compatibility with policy goals. Using action research and in-depth interviews with SEA planners and programme managers enabled us to analyse the suitability of the methodology proposed by the handbook. The results show that some recommendations of the handbook should be changed in order to increase the transparency and to enhance the standard and comparability of the SEA-documents. Overall the SEA proved to be a rather successful tool for the integration of sustainability goals at the EU and national policy levels. Its particular strengths emerged as the process makes uncertainties visible and leads to possible redefinitions while maintaining actual policy goals. - Highlights: Black-Right-Pointing-Pointer Comparing five case studies of first applications of SEA at cohesion policy level. Black-Right-Pointing-Pointer Overall the SEA proved to be a rather successful tool for the integration of sustainability goals. Black-Right-Pointing-Pointer The study makes uncertainties visible and shows how SEA could lead to possible redefinitions.« less

Supporting Policy In health with Research: an Intervention Trial (SPIRIT)—protocol for a stepped wedge trial

PubMed Central

2014-01-01

Introduction Governments in different countries have committed to better use of evidence from research in policy. Although many programmes are directed at assisting agencies to better use research, there have been few tests of the effectiveness of such programmes. This paper describes the protocol for SPIRIT (Supporting Policy In health with Research: an Intervention Trial), a trial designed to test the effectiveness of a multifaceted programme to build organisational capacity for the use of research evidence in policy and programme development. The primary aim is to determine whether SPIRIT results in an increase in the extent to which research and research expertise is sought, appraised, generated and used in the development of specific policy products produced by health policy agencies. Methods and analysis A stepped wedge cluster randomised trial involving six health policy agencies located in Sydney, Australia. Policy agencies are the unit of randomisation and intervention. Agencies were randomly allocated to one of three start dates (steps) to receive the 1-year intervention programme, underpinned by an action framework. The SPIRIT intervention is tailored to suit the interests and needs of each agency and includes audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to assist in the use of research in policies; and exchange with researchers. Outcome measures will be collected at each agency every 6 months for 30 months (starting at the beginning of step 1). Ethics and dissemination Ethics approval was granted by the University of Western Sydney Human Research and Ethics Committee HREC Approval H8855. The findings of this study will be disseminated broadly through peer-reviewed publications and presentations at conferences and used to inform future strategies. PMID:24989620

Women's experiences of developing musculoskeletal diseases: employment challenges and policy recommendations.

PubMed

Crooks, Valorie A

2007-07-30

To answer three specific questions: (i) How do women experience the workplace after the onset of a musculoskeletal disease; (ii) What employment policy and programme suggestions can they offer for ways to better support chronically ill women in their abilities to maintain workforce participation; and (iii) How are these women's employment policy and programme recommendations informed by their own lived experiences and desires? In-depth interviews were conducted with 18 women who had developed musculoskeletal diseases while involved in the labour market. Data were coded and analysed thematically. Participants identified three common workplace barriers experienced and three types of workplace accommodations commonly requested. They offered four specific employment policy and programme recommendations for ways to better support women who develop musculoskeletal diseases in maintaining labour market participation. It is found that their employment policy and programme recommendations are informed by their own experiences in the workplace and desires for being supported in maintaining involvement in paid labour. Creating employment programmes and policies that support chronically ill women in their attempts to remain involved in the workforce based on how much paid labour they are able to perform and where they are best able to work is of the utmost importance.

Structural adjustment programmes adversely affect vulnerable populations: a systematic-narrative review of their effect on child and maternal health.

PubMed

Thomson, Michael; Kentikelenis, Alexander; Stubbs, Thomas

2017-01-01

Structural adjustment programmes of international financial institutions have typically set the fiscal parameters within which health policies operate in developing countries. Yet, we currently lack a systematic understanding of the ways in which these programmes impact upon child and maternal health. The present article systematically reviews observational and quasi-experimental articles published from 2000 onward in electronic databases (PubMed/Medline, Web of Science, Cochrane Library and Google Scholar) and grey literature from websites of key organisations (IMF, World Bank and African Development Bank). Studies were considered eligible if they empirically assessed the aggregate effect of structural adjustment programmes on child or maternal health in developing countries. Of 1961 items yielded through database searches, reference lists and organisations' websites, 13 met the inclusion criteria. Our review finds that structural adjustment programmes have a detrimental impact on child and maternal health. In particular, these programmes undermine access to quality and affordable healthcare and adversely impact upon social determinants of health, such as income and food availability. The evidence suggests that a fundamental rethinking is required by international financial institutions if developing countries are to achieve the Sustainable Development Goals on child and maternal health.

How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes, 2008/2009 to 2014/2015.

PubMed

Jorgensen, Pernille; Mereckiene, Jolita; Cotter, Suzanne; Johansen, Kari; Tsolova, Svetla; Brown, Caroline

2018-01-25

Influenza vaccination is recommended especially for persons at risk of complications. In 2003, the World Health Assembly urged Member States (MS) to increase vaccination coverage to 75% among older persons by 2010. To assess progress towards the 2010 vaccination goal and describe seasonal influenza vaccination recommendations in the World Health Organization (WHO) European Region. Data on seasonal influenza vaccine recommendations, dose distribution, and target group coverage were obtained from two sources: European Union and European Economic Area MS data were extracted from influenza vaccination surveys covering seven seasons (2008/2009-2014/2015) published by the Vaccine European New Integrated Collaboration Effort and European Centre for Disease Prevention and Control. For the remaining WHO European MS, a separate survey on policies and uptake for all seasons (2008/2009-2014/2015) was distributed to national immunization programmes in 2015. Data was available from 49 of 53 MS. All but two had a national influenza vaccination policy. High-income countries distributed considerably higher number of vaccines per capita (median; 139.2 per 1000 population) compared to lower-middle-income countries (median; 6.1 per 1000 population). Most countries recommended vaccination for older persons, individuals with chronic disease, healthcare workers, and pregnant women. Children were included in < 50% of national policies. Only one country reached 75% coverage in older persons (2014/2015), while a number of countries reported declining vaccination uptake. Coverage of target groups was overall low, but with large variations between countries. Vaccination coverage was not monitored for several groups. Despite policy recommendations, influenza vaccination uptake remains suboptimal. Low levels of vaccination is not only a missed opportunity for preventing influenza in vulnerable groups, but could negatively affect pandemic preparedness. Improved understanding of barriers to influenza vaccination is needed to increase uptake and reverse negative trends. Furthermore, implementation of vaccination coverage monitoring is critical for assessing performance and impact of the programmes. Copyright © 2017. Published by Elsevier Ltd.

Into the deep end: incorporating a global health governance and diplomacy experience in graduate public health training.

PubMed

Wipfli, Heather; Kotlewski, Jennifer A

2014-01-01

Global health governance benefits from participants well-versed in the realities of international policy-making. Consequently, educational programmes must establish more opportunities for students to engage in global health policy development. This paper examines a unique global health governance and diplomacy practicum programme at the University of Southern California, designed for Master of Public Health candidates. Through the programme, students act as official non-governmental delegates to the World Health Assembly in Geneva, Switzerland through organisational partnerships. Students and collaborating organisations were asked to complete an online post-participation survey examining the perceived quality of the experience. Through the survey, students indicated reinforcement of classroom learning, continued or heightened interest in global health policy and enthusiasm in recommending the programme to other students. Organisations perceived students to be adequately prepared and indicated their continued desire to work with students in the programme. The data collected suggest that the programme was successful in providing students with a worthwhile experience that developed skills in global health diplomacy and promoted interest and critical thinking concerning international policy-making processes. A discussion of strengths and challenges serves as a blueprint for the creation of future practicum programmes.

Global population trends and policy options.

PubMed

Ezeh, Alex C; Bongaarts, John; Mberu, Blessing

2012-07-14

Rapid population growth is a threat to wellbeing in the poorest countries, whereas very low fertility increasingly threatens the future welfare of many developed countries. The mapping of global trends in population growth from 2005-10 shows four distinct patterns. Most of the poorest countries, especially in sub-Saharan Africa, are characterised by rapid growth of more than 2% per year. Moderate annual growth of 1-2% is concentrated in large countries, such as India and Indonesia, and across north Africa and western Latin America. Whereas most advanced-economy countries and large middle-income countries, such as China and Brazil, are characterised by low or no growth (0-1% per year), most of eastern Europe, Japan, and a few western European countries are characterised by population decline. Countries with rapid growth face adverse social, economic, and environmental pressures, whereas those with low or negative growth face rapid population ageing, unsustainable burdens on public pensions and health-care systems, and slow economic growth. Countries with rapid growth should consider the implementation of voluntary family planning programmes as their main policy option to reduce the high unmet need for contraception, unwanted pregnancies, and probirth reproductive norms. In countries with low or negative growth, policies to address ageing and very low fertility are still evolving. Further research into the potential effect of demographic policies on other social systems, social groups, and fertility decisions and trends is therefore recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

Gender Equality Matters: Empowering Women through Literacy Programmes. UIL Policy Brief 3

ERIC Educational Resources Information Center

UNESCO Institute for Lifelong Learning, 2014

2014-01-01

The third in UIL's current series of policy briefs, titled "Gender equality matters: Empowering women through literacy programmes," offers research-informed analysis and action-oriented recommendations for local and national governments, providers of literacy programmes and educators on how to reduce the gender gap in adult literacy.…

The Impact of Foreign Policy on Educational Exchange: The Swedish State Scholarship Programme 1938-1990

ERIC Educational Resources Information Center

Åkerlund, Andreas

2014-01-01

Programmes of international educational exchange are not only carried out for educational purposes, but form an important part of modern-day public diplomacy. Through exchange programmes education and research are linked with foreign policy interests, which then in turn should affect the international contacts of universities and research…

The use and impact of cancer medicines in routine clinical care: methods and observations in a cohort of elderly Australians

PubMed Central

Pearson, Sallie-Anne; Schaffer, Andrea

2014-01-01

Introduction After medicines have been subsidised in Australia we know little about their use in routine clinical practice, impact on resource utilisation, effectiveness or safety. Routinely collected administrative health data are available to address these issues in large population-based pharmacoepidemiological studies. By bringing together cross-jurisdictional data collections that link drug exposure to real-world outcomes, this research programme aims to evaluate the use and impact of cancer medicines in a subset of elderly Australians in the real-world clinical setting. Methods and analysis This ongoing research programme involves a series of retrospective cohort studies of Australian Government Department of Veterans’ Affairs (DVA) clients. The study population includes 104 635 veterans who reside in New South Wales, Australia, and were aged 65 years and over as of 1 July 2004. We will investigate trends in cancer medicines use according to cancer type and other sociodemographic characteristics as well as predictors of the initiation of cancer medicines and other treatment modalities, survival and adverse outcomes among patients with cancer. The programme is underpinned by the linkage of eight health administrative databases under the custodianship of the DVA and the New South Wales Ministry of Health, including cancer notifications, medicines dispensing data, hospitalisation data and health services data. The cancer notifications database is available from 1994 with all other databases available from 2005 onwards. Ethics and dissemination Ethics approval has been granted by the DVA and New South Wales Population and Health Service Research Ethics Committees. Results Results will be reported in peer-reviewed publications, conference presentations and policy forums. The programme has high translational potential, providing invaluable evidence about cancer medicines in an elderly population who are under-represented in clinical trials. PMID:24793244

Changing landscapes, changing practice: negotiating access to sleeping sickness services in a post-conflict society.

PubMed

Palmer, Jennifer J; Kelly, Ann H; Surur, Elizeous I; Checchi, Francesco; Jones, Caroline

2014-11-01

For several decades, control programmes for human African trypanosomiasis (HAT, or sleeping sickness) in South Sudan have been delivered almost entirely as humanitarian interventions: large, well-organised, externally-funded but short-term programmes with a strategic focus on active screening. When attempts to hand over these programmes to local partners fail, resident populations must actively seek and negotiate access to tests at hospitals via passive screening. However, little is known about the social impact of such humanitarian interventions or the consequences of withdrawal on access to and utilisation of remaining services by local populations. Based on qualitative and quantitative fieldwork in Nimule, South Sudan (2008-2010), where passive screening necessarily became the predominant strategy, this paper investigates the reasons why, among two ethnic groups (Madi returnees and Dinka displaced populations), service uptake was so much higher among the latter. HAT tests were the only form of clinical care for which displaced Dinka populations could self-refer; access to all other services was negotiated through indigenous area workers. Because of the long history of conflict, these encounters were often morally and politically fraught. An open-door policy to screening supported Dinka people to 'try' HAT tests in the normal course of treatment-seeking, thereby empowering them to use HAT services more actively. This paper argues that in a context like South Sudan, where HAT control increasingly depends upon patient-led approaches to case-detection, it is imperative to understand the cultural values and political histories associated with the practice of testing and how medical humanitarian programmes shape this landscape of care, even after they have been scaled down. Copyright © 2014 Elsevier Ltd. All rights reserved.

Research for food and health in Europe: themes, needs and proposals.

PubMed

McCarthy, Mark; Aitsi-Selmi, Amina; Bánáti, Diána; Frewer, Lynn; Hirani, Vasant; Lobstein, Tim; McKenna, Brian; Mulla, Zenab; Rabozzi, Giulia; Sfetcu, Raluca; Newton, Rachel

2011-09-29

Diet, in addition to tobacco, alcohol and physical exercise, is a major factor contributing to chronic diseases in Europe. There is a pressing need for multidisciplinary research to promote healthier food choices and better diets. Food and Health Research in Europe (FAHRE) is a collaborative project commissioned by the European Union. Among its tasks is the description of national research systems for food and health and, in work reported here, the identification of strengths and gaps in the European research base. A typology of nine research themes was developed, spanning food, society, health and research structures. Experts were selected through the FAHRE partners, with balance for individual characteristics, and reported using a standardised template. Countries usually commission research on food, and on health, separately: few countries have combined research strategies or programmes. Food and health are also strongly independent fields within the European Commission's research programmes. Research programmes have supported food and bio-technology, food safety, epidemiological research, and nutritional surveillance; but there has been less research into personal behaviour and very little on environmental influences on food choices - in the retail and marketing industries, policy, and regulation. The research is mainly sited within universities and research institutes: there is relatively little published research contribution from industry. National food policies, based on epidemiological evidence and endorsed by the World Health Organisation, recommend major changes in food intake to meet the challenge of chronic diseases. Biomedical and biotechnology research, in areas such as 'nutrio-genomics', 'individualised' diets, 'functional' foods and 'nutri-pharmaceuticals' appear likely to yield less health benefit, and less return on public investment, than research on population-level interventions to influence dietary patterns: for example policies to reduce population consumption of trans fats, saturated fats, salt and energy density. Research should now address how macro-diets, rather than micro-nutritional content, can be improved for beneficial impacts on health, and should evaluate the impact of market changes and policy interventions, including regulation, to improve public health. European and national research on food and health should have social as well as commercial benefits. Strategies and policies should be developed between ministries of health and national research funding agencies. Collaboration between member states in the European Union can yield better innovation and greater competitive advantage.

Research for food and health in Europe: themes, needs and proposals

PubMed Central

2011-01-01

Background Diet, in addition to tobacco, alcohol and physical exercise, is a major factor contributing to chronic diseases in Europe. There is a pressing need for multidisciplinary research to promote healthier food choices and better diets. Food and Health Research in Europe (FAHRE) is a collaborative project commissioned by the European Union. Among its tasks is the description of national research systems for food and health and, in work reported here, the identification of strengths and gaps in the European research base. Methods A typology of nine research themes was developed, spanning food, society, health and research structures. Experts were selected through the FAHRE partners, with balance for individual characteristics, and reported using a standardised template. Results Countries usually commission research on food, and on health, separately: few countries have combined research strategies or programmes. Food and health are also strongly independent fields within the European Commission's research programmes. Research programmes have supported food and bio-technology, food safety, epidemiological research, and nutritional surveillance; but there has been less research into personal behaviour and very little on environmental influences on food choices - in the retail and marketing industries, policy, and regulation. The research is mainly sited within universities and research institutes: there is relatively little published research contribution from industry. Discussion National food policies, based on epidemiological evidence and endorsed by the World Health Organisation, recommend major changes in food intake to meet the challenge of chronic diseases. Biomedical and biotechnology research, in areas such as 'nutrio-genomics', 'individualised' diets, 'functional' foods and 'nutri-pharmaceuticals' appear likely to yield less health benefit, and less return on public investment, than research on population-level interventions to influence dietary patterns: for example policies to reduce population consumption of trans fats, saturated fats, salt and energy density. Research should now address how macro-diets, rather than micro-nutritional content, can be improved for beneficial impacts on health, and should evaluate the impact of market changes and policy interventions, including regulation, to improve public health. Conclusions European and national research on food and health should have social as well as commercial benefits. Strategies and policies should be developed between ministries of health and national research funding agencies. Collaboration between member states in the European Union can yield better innovation and greater competitive advantage. PMID:21958161

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance.

PubMed

Wolf, R Cameron; Adams, Darrin; Dayton, Robyn; Verster, Annette; Wong, Joe; Romero, Marcela; Mazin, Rafael; Settle, Edmund; Sladden, Tim; Keatley, JoAnne

2016-01-01

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.

Towards an empowerment approach in tuberculosis treatment in Cape Town, South Africa: a qualitative analysis of programmatic change

PubMed Central

Atkins, Salla; Lewin, Simon; Ringsberg, Karin C.; Thorson, Anna

2012-01-01

Background Tuberculosis rates in the world remain high, especially in low- and middle-income countries. International tuberculosis (TB) policy generally recommends the use of directly observed therapy (DOT) to ensure treatment adherence. Objective This article examines a change in TB treatment support that occurred in 2005 in South Africa, from DOT to the enhanced TB adherence programme (ETA). Design Seven key individuals representing academics, policy makers and service providers involved in the development of the ETA programme or knowledgeable about the issue were purposively sampled and interviewed, and participant observation was conducted at ETA programme steering group meetings. Qualitative content analysis was used to analyse the data, drawing on the Kingdon model of agenda setting. This model suggests that three independent streams – problem, policy and politics – come together at a certain point, often facilitated by policy entrepreneurs, to provide an opportunity for an issue to enter the policy agenda. Results The results suggest the empowerment-oriented programme emerged through the presence of policy entrepreneurs with access to resources. Policy entrepreneurs were influenced by a number of simultaneously occurring challenges including problems within the existing programme; a perceived mismatch between patient needs and the existing TB treatment model; and the TB-HIV co-epidemic. Policy entrepreneurs saw the ART approach as a possible solution to these challenges. Conclusions The Kingdon model contributed to describing the process of policy change. Research evidence seemed to influence this change diffusely, through the interaction of policy entrepreneurs and academics. PMID:22902052

The next 5 years of global HIV/AIDS policy: critical gaps and strategies for effective responses.

PubMed

Szekeres, Greg

2008-08-01

The University of California, Los Angeles Program in Global Health performed a landscape analysis based on interviews conducted between November 2006 and February 2007 with 35 key informants from major international organizations conducting HIV/AIDS work. Institutions represented included multilateral organizations, foundations, and governmental and non-governmental organizations. The purpose of this analysis is to assist major foundations and other institutions to understand better the international HIV/AIDS policy landscape and to formulate research and development programmes that can make a significant contribution to moving important issues forward in the HIV/AIDS policy arena. Topics identified during the interviews were organized around the four major themes of the Ford Foundation's Global HIV/AIDS Initiative: leadership and leadership development; equity; accountability; and global partnerships. Key informants focused on the need for a visionary response to the HIV pandemic, the need to maintain momentum, ways to improve the scope of leadership development programmes, ideas for improving gender equity and addressing regional disparities and the needs of vulnerable populations, recommendations for strengthening accountability mechanisms among governments, foundations, and civil society and on calling for increased collaboration and partnership among key players in the global HIV/AIDS response.

Salient Features of a Proposed Adolescent Health Policy Draft for India

PubMed Central

Dehury, Ranjit Kumar

2017-01-01

India is one of the most populous countries in the world. The adolescent population in India constitutes about one fifth of the total Indian population. Adolescent phase is a transitional phase in life and the adolescents are neither child nor adult at this stage and are full of energy, have significant drive and new ideas. The relatively lower death rate and relatively good health status of the adolescents has always been a misleading measure to adolescent health and thus given lesser priorities. In order to respond effectively to the needs of adolescent health and development, it is important to place adolescence in a life-span perspective within dynamic sociological, cultural and economic realities. For this, government of India has started a national programme known as “Rashtriya Kishor Swathya Karyakram” in 2014. However, India as a country does not have an adolescent health policy till date and hence the country requires a national adolescent health policy. The key priorities should include sexual and reproductive health, nutritional problems (both under and over nutrition), substance abuse, mental health, road traffic accidents, intentional violence and non-communicable diseases. In addition to key priorities, the policy draft should include pertinent components such as a preamble, guiding principles, coordinating agencies, monitoring and evaluation, research and documentation components. PMID:28658817

Salient Features of a Proposed Adolescent Health Policy Draft for India.

PubMed

Samal, Janmejaya; Dehury, Ranjit Kumar

2017-05-01

India is one of the most populous countries in the world. The adolescent population in India constitutes about one fifth of the total Indian population. Adolescent phase is a transitional phase in life and the adolescents are neither child nor adult at this stage and are full of energy, have significant drive and new ideas. The relatively lower death rate and relatively good health status of the adolescents has always been a misleading measure to adolescent health and thus given lesser priorities. In order to respond effectively to the needs of adolescent health and development, it is important to place adolescence in a life-span perspective within dynamic sociological, cultural and economic realities. For this, government of India has started a national programme known as " Rashtriya Kishor Swathya Karyakram " in 2014. However, India as a country does not have an adolescent health policy till date and hence the country requires a national adolescent health policy. The key priorities should include sexual and reproductive health, nutritional problems (both under and over nutrition), substance abuse, mental health, road traffic accidents, intentional violence and non-communicable diseases. In addition to key priorities, the policy draft should include pertinent components such as a preamble, guiding principles, coordinating agencies, monitoring and evaluation, research and documentation components.

National Adult Education Programme: Policy Statement and Programme Outline. Government of India's Policy Statement on Adult Education

ERIC Educational Resources Information Center

New Frontiers in Education, 1978

1978-01-01

An eight-point policy statement on adult education in India is presented, followed by an outline of operational details for putting it into effect. Focus is on combatting illiteracy by providing those citizens with skills for self-directed learning. (LBH)

1980 ASEAN programme roundup: a model in the making.

PubMed

1981-01-01

Association of Southeast Asian Nations (ASEAN) experts and heads of national population programs held their 4th meeting in Singapore from November 24-28, 1980. Program heads resolved to take steps to link their national activities in the population field with those of the ASEAN Population Program and carry out studies and a joint programming exercise in 1981. Progress reports on the following Phase 1 projects were given: 1) integration of population and rural development policies and programs in ASEAN countries including Indonesia, Malaysia, Philippines, Singapore, and Thailand; 2) development of an inter-country modular training program for personnel in population and rural development; 3) multi-media support for population programs in the context of rural development in ASEAN countries; 4) utilization of research findings in population and family planning for policy formulation and program management in ASEAN countries; and 5) migration in relation to rural development. Phase 2 projects approved by ASEAN country participants were also discussed: 1) institutional development and exchange of personnel, 2) women in development, 3) developing and strengthening national population information systems and networks in ASEAN countries, 4) population and development dynamics and the man/resource balance, 5) studies on health and family planning in ASEAN countries, 6) population migration movement and development, and 7) development of ASEAN social indicators.

Distributional cost-effectiveness analysis in low- and middle-income countries: illustrative example of rotavirus vaccination in Ethiopia.

PubMed

Dawkins, Bryony R; Mirelman, Andrew J; Asaria, Miqdad; Johansson, Kjell Arne; Cookson, Richard A

2018-04-01

Reducing health inequality is a major policy concern for low- and middle-income countries (LMICs) on the path to universal health coverage. However, health inequality impacts are rarely quantified in cost-effectiveness analyses of health programmes. Distributional cost-effectiveness analysis (DCEA) is a method developed to analyse the expected social distributions of costs and health benefits, and the potential trade-offs that may exist between maximising total health and reducing health inequality. This is the first paper to show how DCEA can be applied in LMICs. Using the introduction of rotavirus vaccination in Ethiopia as an illustrative example, we analyse a hypothetical re-designed vaccination programme, which invests additional resources into vaccine delivery in rural areas, and compare this with the standard programme currently implemented in Ethiopia. We show that the re-designed programme has an incremental cost-effectiveness ratio of US$69 per health-adjusted life year (HALY) compared with the standard programme. This is potentially cost-ineffective when compared with current estimates of health opportunity cost in Ethiopia. However, rural populations are typically less wealthy than urban populations and experience poorer lifetime health. Prioritising such populations can thus be seen as being equitable. We analyse the trade-off between cost-effectiveness and equity using the Atkinson inequality aversion parameter, ε, representing the decision maker's strength of concern for reducing health inequality. We find that the more equitable programme would be considered worthwhile by a decision maker whose inequality concern is greater than ε = 5.66, which at current levels of health inequality in Ethiopia implies that health gains are weighted at least 3.86 times more highly in the poorest compared with the richest wealth quintile group. We explore the sensitivity of this conclusion to a range of assumptions and cost-per-HALY threshold values, to illustrate how DCEA can inform the thinking of decision makers and stakeholders about health equity trade-offs.

The Evidence Base for Early Childhood Education and Care Programme Investment: What We Know, What We Don't Know

ERIC Educational Resources Information Center

White, Linda A.; Prentice, Susan; Perlman, Michal

2015-01-01

An expanding body of research demonstrates that high quality early childhood education and care (ECEC) programmes generate positive outcomes for children; in response, policy makers in a number of countries are making significant programme investments. No research consensus, however, has emerged around the specific types of policy intervention…

Breaking the silence: South African HIV policies and the needs of men who have sex with men.

PubMed

Rispel, Laetitia C; Metcalf, Carol A

2009-05-01

Although the HIV epidemic among men who have sex with men (MSM) in South Africa preceded the onset of the generalised HIV epidemic by several years, current policies and programmes focus on heterosexual transmission and mother-to-child transmission. We used an adaptation of the UNAIDS Country Harmonised Alignment Tool (CHAT) to assess whether existing HIV policies and programmes in South Africa address the needs of MSM. This covered mapping of key risk factors and epidemiology of HIV among MSM; participation of MSM in the HIV response; and an enabling environment for service provision, funding and human resources. We found that current policies and programmes are unresponsive to the needs of MSM and that epidemiologic information is lacking, in spite of policy on MSM in the National Strategic Plan. We recommend that government initiate sentinel surveillance to determine HIV prevalence among MSM, social science research on the contexts of HIV transmission among MSM, and appropriate HIV prevention and care strategies. MSM should be closely involved in the design of policies and programmes. Supportive programme development should include dedicated financial and human resources, appropriate guidelines, and improved access to and coverage of HIV prevention, treatment and care services for MSM.

Rapid Reviews in Health Policy: A Study of Intended Use in the New South Wales' Evidence Check Programme

ERIC Educational Resources Information Center

Moore, Gabriel Mary; Redman, Sally; Turner, Tari; Haines, Mary

2016-01-01

Rapid reviews of research are a key way in which policy makers use research. This paper examines 74 rapid reviews commissioned by health policy agencies through the Sax Institute's Evidence Check programme. We examine what prompted policy makers to commission rapid reviews, their purpose, how and when they intended to use them, and how this varied…

Effective use of fluorides in the People's Republic of China--a model for WHO Mega Country initiatives.

PubMed

Petersen, P E; Kwan, S; Zhu, L; Zhang, B X; Bian, J Y

2008-12-01

Poor dental health has been reported in the Chinese National Surveys of Oral Health. With the changing lifestyle and growing consumption of sugars, the incidence of dental caries may well continue to rise, compounded by limited access to professional care. The increasing oral disease burden could become a major public health problem in China, leading to considerable personal and health service costs. There is a desperate need for systematic implementation of preventive programmes. Currently, China is strengthening the prevention of chronic diseases, which provides an excellent opportunity to integrate oral disease prevention into the overall non-communicable disease (NCD) prevention programmes. In order to address this growing public health problem, the World Health Organization (WHO) Global Oral Health Programme advocates the effective use of fluoride as an essential approach to prevent dental caries in the 21st century--part of the WHO Global Oral Health Strategy. Population-wide automatic fluoridation measures are considered the most effective, complemented by appropriate use of toothpastes containing fluoride. There are wide variations of fluoride levels in drinking water in China and, in many areas, the levels of fluoride in drinking water are lower than the recommended levels. The use of toothpaste containing fluoride is still too low in some areas and decreases with age. Those who live in rural areas have limited access to affordable toothpastes containing fluoride. In March 2006, as part of the WHO Mega Country Health Promotion Network initiatives, the WHO Global Oral Health Programme organised a three-day symposium in Beijing, People's Republic of China. The aim of the symposium was to bring together international experience and Chinese expertise to facilitate policy development for effective use of fluoride in China, highlighting the benefits of, and barriers to, the implementation of different fluoridation programmes at the strategic levels as well as for operational planning. This article reports the proceedings of the meeting. In summary, China is a Mega country with much diversity and disparity. The situation in China is unique with endemic fluorosis due to other non-water sources of fluoride in some areas and a considerable dental caries burden in others. It is important to regulate the appropriate exposure to fluoride to obtain the benefits and avoid adverse effects of fluorides, controlling enamel fluorosis without jeopardising the prevention of dental caries. Various complementary fluoridation programmes can be considered for different population groups with varying needs, strategies that bring about additive effects. A multi-tier policy making approach at national, regional and provincial levels can be employed, based on sound evidence. The roles of WHO, Ministry of Health and the National Committee for Oral Health (NCOH) were emphasised. Lessons learned from the Chinese experience will prove invaluable to other countries with similar socio demographic characteristics that are in the same process of developing and implementing fluoridation policies and programmes.

Leadership as a Health Research Policy Intervention: An Evaluation of the NIHR Leadership Programme (Phase 2).

PubMed

Marjanovic, Sonja; Cochrane, Gavin; Manville, Catriona; Harte, Emma; Chataway, Joanna; Jones, Molly Morgan

2016-01-29

In early 2012, the National Institute for Health Research (NIHR) leadership programme was re-commissioned for a further three years following an evaluation by RAND Europe. During this new phase of the programme, we conducted a real-time evaluation, the aim of which was to allow for reflection on and adjustment of the programme on an on-going basis as events unfold. This approach also allowed for participants on the programme to contribute to and positively engage in the evaluation. The study aimed to understand the outputs and impacts from the programme, and to test the underlying assumptions behind the NIHR Leadership Programme as a science policy intervention. Evidence on outputs and impacts of the programme were collected around the motivations and expectations of participants, programme design and individual-, institutional- and system-level impacts.

The Parliamentarian, NGO and Youth Fora.

PubMed

1999-01-01

Three fora, namely, the Parliamentarian's Forum, the Nongovernmental Organization (NGO) Forum, and the Youth Forum, immediately preceded the Hague Forum. Each of the forums assessed achievements in implementing the International Conference on Population and Development Programme of Action (ICPD-PA) and formulated recommendations that provided valuable input to the International Forum. The Parliamentarian's Forum, attended by 210 parliamentarians from 103 countries, evaluated the progress in development of the parliamentarians' movement after the ICPD. The parliamentarians focused their discussions on the following priority areas: reproductive health and rights; gender and population; adolescents, youth, the elderly, and persons with disabilities; population, environment, and food security; resource mobilization; economic crises; and parliamentarian networks. The NGO Forum, on the other hand, emphasized the need to achieve consensus on policy formulation that includes NGOs as partners; establish permanent mechanisms for ICPD-PA implementation; and mobilize financial resources for sexual and reproductive health initiatives. Lastly, the Youth Forum highlighted the central role that youth can play in the development of policies and programs for ICPD-PA implementation.

Diagnosing avian influenza infection in vaccinated populations by systems for differentiating infected from vaccinated animals (DIVA).

PubMed

Capua, I; Cattoli, G

2007-01-01

Vaccination against avian influenza is recommended as a tool to support control measures in countries affected by avian influenza. Vaccination is known to increase the resistance of susceptible birds to infection and also to reduce shedding; however, it does not always prevent infection. Vaccinated infected flocks can therefore be a source of infection and thus be responsible for the perpetuation of infection. To avoid the spread of infection in a vaccinated population, immunization strategies must allow differentiation of infected from vaccinated animals (DIVA), combined with an appropriate monitoring system. Vaccinated exposed flocks must be identified and managed by restriction policies that include controlled marketing and stamping-out. Several vaccines and diagnostic tests to detect infection in vaccinated populations are available, the tests having various properties and characteristics. In order to achieve eradication, the most appropriate DIVA vaccination strategy must be identified and an appropriate monitoring programme be designed, taking into account risk factors, the epidemiological situation and the socioeconomic implications of the policy.

Introducing Vi polysaccharide typhoid fever vaccine to primary school children in North Jakarta, Indonesia, via an existent school-based vaccination platform.

PubMed

Agtini, M D; Ochiai, R L; Soeharno, R; Lee, H J; Sundoro, J; Hadinegoro, S R; Han, O P; Tana, L; Halim, F X S; Ghani, L; Delima; Lestari, W; Sintawati, F X; Kusumawardani, N; Malik, R; Santoso, T S; Nadjib, M; Soeroso, S; Wangsasaputra, F; Ali, M; Ivanoff, B; Galindo, C M; Pang, T; Clemens, J D; Suwandono, A; Acosta, C J

2006-11-01

To report results on coverage, safety and logistics of a large-scale, school-based Vi polysaccharide immunization campaign in North Jakarta. Of 443 primary schools in North Jakarta, Indonesia, 18 public schools were randomly selected for this study. Exclusion criteria were fever 37.5 degrees C or higher at the time of vaccination or a known history of hypersensitivity to any vaccine. Adverse events were monitored and recorded for 1 month after immunization. Because this was a pilot programme, resource use was tracked in detail. During the February 2004 vaccination campaign, 4828 students were immunized (91% of the target population); another 394 students (7%) were vaccinated during mop-up programmes. Informed consent was obtained for 98% of the target population. In all, 34 adverse events were reported, corresponding to seven events per 1000 doses injected; none was serious. The manufacturer recommended cold chain was maintained throughout the programme. This demonstration project in two sub-districts of North Jakarta shows that a large-scale, school-based typhoid fever Vi polysaccharide vaccination campaign is logistically feasible, safe and minimally disruptive to regular school activities, when used in the context of an existing successful immunization platform. The project had high parental acceptance. Nonetheless, policy-relevant questions still need to be answered before implementing a widespread Vi polysaccharide vaccine programme in Indonesia.

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice

PubMed Central

Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S; Wilson, Nevin C; Kumar, Ajay M V; Oeltmann, John E; Chadha, Vineet K; Nagaraja, Sharath Burugina; Ghosh, Smita; Q Lo, Terrence; Volkmann, Tyson; Willis, Matthew; Shringarpure, Kalpita; Reddy, Ravichandra Chinnappa; Kumar, Prahlad; Nair, Sreenivas A; Rao, Raghuram; Yassin, Mohammed; Mwangala, Perry; Zachariah, Rony; Tonsing, Jamhoih; Harries, Anthony D; Khaparde, Sunil

2018-01-01

ABSTRACT Background: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes. Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects. PMID:29553308

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice.

PubMed

Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S; Wilson, Nevin C; Kumar, Ajay M V; Moonan, Patrick K; Oeltmann, John E; Chadha, Vineet K; Nagaraja, Sharath Burugina; Ghosh, Smita; Q Lo, Terrence; Volkmann, Tyson; Willis, Matthew; Shringarpure, Kalpita; Reddy, Ravichandra Chinnappa; Kumar, Prahlad; Nair, Sreenivas A; Rao, Raghuram; Yassin, Mohammed; Mwangala, Perry; Zachariah, Rony; Tonsing, Jamhoih; Harries, Anthony D; Khaparde, Sunil

2018-01-01

The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes. In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.

Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes.

PubMed

Dalziel, Kim; Segal, Leonie

2012-09-01

There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.

Policy Goals of European Integration and Competitiveness in Academic Collaborations: An Examination of Joint Master's and Erasmus Mundus Programmes

ERIC Educational Resources Information Center

Papatsiba, Vassiliki

2014-01-01

This study examines policy goals pertaining to joint Master's in Europe as presented in Bologna-related and Erasmus Mundus (EM) policy texts. The profile of joint programmes has risen in the aftermath of the Bologna Process (BP), together with the launch of the EU EM. Despite a European policy tradition of cooperation in higher education (HE),…

Situational analysis of infant and young child nutrition policies and programmatic activities in Chad.

PubMed

Wuehler, Sara E; Nadjilem, Djasndibye

2011-04-01

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs). Therefore, several international agencies joined to 'reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse, and interpret available information on infant and child feeding, and the nutrition situation of children <2 years of age in Chad, as one of the six targeted countries. These findings are available to assist in identifying inconsistencies and filling gaps in current programming. Between June and October of 2008, key informants responsible for IYCN-related activities in Chad were interviewed, and 53 documents were examined on the following themes: the promotion of optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, management of acute malnutrition, prevention of mother-to-child transmission of human immunodeficiency virus (HIV), food security, and promotion of good hygienic practices. Chad is not on track to reaching the MDGs of reducing mortality by two-thirds and malnutrition by half among children <5 years of age between 1990 and 2015. Most of the key IYCN topics were addressed in a national policy to combat malnutrition and micronutrient deficiencies. No national nutrition policy was yet ratified in Chad, so the target of many documents reviewed was the malnourished child. Researchers have identified some barriers to optimal feeding practices. However, the majority of these surveys were small scale, so they do not necessarily provide information relevant to the general population. Expanded surveys would be needed for developing evidence-based educational messages targeted to local needs. Reviewed training materials and related programmes being implemented in Chad provide specific guidance for nearly all of the key IYCN topics, except for appropriate feeding choices for the prevention of mother-to-child transmission of HIV. Some of the programmes were intended for national coverage, but we could not confirm whether these programmes were actually implemented nationally. Monitoring and evaluation reports were available for some small-scale programmes, but few of these evaluated whether IYCN-specific programme components were implemented as designed and none evaluated whether participants adopted the promoted feeding practices. Establishment of the policy and programme framework has commenced for improving IYCN practices. Formative research is needed to guide the development of evidence-based training materials and programmes to address the nutritional needs of infants and children. Once more directed programmes are established, there is a further need for rigorous monitoring and evaluation to ensure that training is adequate, programmes are implemented as designed, and effective programmes are identified for expansion nationally. Evaluations are also needed to determine where human and institutional capacity building is needed to carry out these activities as they are implemented. National and international support will be required to complete these enhancements, and thus improve the health and nutritional status of infants and young children in Chad. © 2011 Blackwell Publishing Ltd.

Free formula milk in the prevention of mother-to-child transmission programme: voices of a peri-urban community in South Africa on policy change.

PubMed

Ijumba, Petrida; Doherty, Tanya; Jackson, Debra; Tomlinson, Mark; Sanders, David; Persson, Lars-Åke

2013-10-01

In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme. To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa. An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis. Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change. There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.

Development of an intervention programme to encourage high school students to stay in school for lunch instead of eating at nearby fast-food restaurants.

PubMed

Beaulieu, Dominique; Godin, Gaston

2012-08-01

Many schools have recently adopted food policies and replaced unhealthy products by healthy foods. Consequently, adolescents are more likely to consume a healthy meal if they stay in school for lunch to eat a meal either prepared at home or purchased in school cafeterias. However, many continue to eat in nearby fast-food restaurants. The present paper describes the development of a theory-based intervention programme aimed at encouraging high school students to stay in school for lunch. Intervention Mapping and the Theory of Planned Behaviour served as theoretical frameworks to guide the development of a 12-week intervention programme of activities addressing intention, descriptive norm, perceived behavioural control and attitude. It was offered to students and their parents with several practical applications, such as structural environmental changes, and educational activities, such as audio and electronic messages, posters, cooking sessions, pamphlets, improvisation play theatre, quiz, and conferences. The programme considers theoretical and empirical data, taking into account specific beliefs and contexts of the target population. This paper should help programme planners in the development of appropriate interventions addressing the problem. Copyright © 2012 Elsevier Ltd. All rights reserved.

Implementation of a health policy advisory committee as a knowledge translation platform: the Nigeria experience

PubMed Central

Uneke, Chigozie Jesse; Ndukwe, Chinwendu Daniel; Ezeoha, Abel Abeh; Uro-Chukwu, Henry Chukwuemeka; Ezeonu, Chinonyelum Thecla

2015-01-01

Background: In recent times, there has been a growing demand internationally for health policies to be based on reliable research evidence. Consequently, there is a need to strengthen institutions and mechanisms that can promote interactions among researchers, policy-makers and other stakeholders who can influence the uptake of research findings. The Health Policy Advisory Committee (HPAC) is one of such mechanisms that can serve as an excellent forum for the interaction of policy-makers and researchers. Therefore, the need to have a long term mechanism that allows for periodic interactions between researchers and policy-makers within the existing government system necessitated our implementation of a newly established HPAC in Ebonyi State Nigeria, as a Knowledge Translation (KT) platform. The key study objective was to enhance the capacity of the HPAC and equip its members with the skills/competence required for the committee to effectively promote evidence informed policy-making and function as a KT platform. Methods: A series of capacity building programmes and KT activities were undertaken including: i) Capacity building of the HPAC using Evidence-to-Policy Network (EVIPNet) SUPPORT tools; ii) Capacity enhancement mentorship programme of the HPAC through a three-month executive training programme on health policy/health systems and KT in Ebonyi State University Abakaliki; iii) Production of a policy brief on strategies to improve the performance of the Government’s Free Maternal and Child Health Care Programme in Ebonyi State Nigeria; and iv) Hosting of a multi-stakeholders policy dialogue based on the produced policy brief on the Government’s Free Maternal and Child Health Care Programme. Results: The study findings indicated a noteworthy improvement in knowledge of evidence-to-policy link among the HPAC members; the elimination of mutual mistrust between policy-makers and researchers; and an increase in the awareness of importance of HPAC in the Ministry of Health (MoH). Conclusion: Findings from this study suggest that a HPAC can function as a KT platform and can introduce a new dimension towards facilitating evidence-to-policy link into the operation of the MoH, and can serve as an excellent platform to bridge the gap between research and policy. PMID:25774373

On the Impact of Government Policy on Programme Design in New Zealand Post-Compulsory Education

ERIC Educational Resources Information Center

Govers, Elly

2010-01-01

The impact of national education policies on programme design practice in post-compulsory education tends to be marginalised in scholarly literature. This paper reviews and analyses the literature to explore how neo-liberalist discourses introduced in tertiary education and qualifications policies in New Zealand since 1989 continue to influence…

Effective promotion of healthy nutrition and physical activity in Europe requires skilled and competent people; European Master's Programme in Public Health Nutrition.

PubMed

Yngve, A; Sjöström, M; Warm, D; Margetts, B; Rodrigo, C P; Nissinen, A

1999-09-01

Scientists in basic research and epidemiology deliver messages to policy makers. Effective population based strategies then require people trained and competent in the discipline of Public Health Nutrition (PHN). Since 1997, a European Master's Programme in PHN has been undergoing planning and implementation with the aid of funding from the European Commission (DGV). PHN is used as a broad term covering Nutrition and Physical Activity as well as Health Promotion and Disease Prevention. The partners in this project are academic departments from 17 countries. The students will undertake core modules and electives for a year and a half, followed by a research project for six months. In order to set up formalised procedures for the evaluation of the quality assurance of individual modules from across Europe, a quality assurance system has been set up. The academic year 1999-2000 will allow an opportunity for Universities and Institutes to start new modules, to develop other modules, assess the movement of students between modules, tackle funding issues and allow further marketing of the programme. Future activities include strengthening of the European Network for Public Health Nutrition (ENPHN), the establishment of a consortium with universities, the co-ordination of programme activities with other European Master's Programmes in Public Health, and the incorporation of new Member States from Eastern Europe. We can look forward to a new brand of professionals, who are truly European in their training, but who also have an integrated view of nutrition and physical activity, health promotion and disease prevention and who are prepared for policy making, action planning, implementation and evaluation.

Impact of an effective multidrug-resistant tuberculosis control programme in the setting of an immature HIV epidemic: system dynamics simulation model.

PubMed

Atun, Rifat A; Lebcir, Reda; Drobniewski, Francis; Coker, Richard J

2005-08-01

This study sought to determine the impact of an effective programme of multidrug resistant tuberculosis control (MDRTB) on a population that is witnessing an explosive HIV epidemic among injecting drug users (IDUs), where the prevalence of MDRTB is already high. A transmission model was constructed that represents the dynamics of the drug-susceptible tuberculosis (DSTB), MDRTB and HIV spread among the adult population of Samara Oblast, Russia: from official notifications of tuberculosis and of HIV infection, estimates of MDRTB derived from surveillance studies, population data from official regional statistics, data on transmission probabilities from peer-reviewed publications and informed estimates, and policy-makers' estimates of IDU populations. Two scenarios of programme effectiveness for MDRTB were modelled and run over a period of 10 years to predict cumulative deaths. In a population of 3.3 million with a high prevalence of MDRTB, an emerging epidemic of HIV among IDUs, and a functioning directly observed therapy-short course (DOTS) programme, the model predicts that under low cure rates for MDRTB the expected cumulative deaths from tuberculosis will reach 6303 deaths including 1900 deaths from MDRTB at 10 years. Under high cure rate for MDRTB 4465 deaths will occur including 134 deaths from MDRTB. At 10 years there is little impact on HIV-infected populations from the MDRTB epidemic, but as the HIV epidemic matures the impact becomes substantial. When the model is extended to 20 years cumulative deaths from MDRTB become very high if cure rates for MDRTB are low and cumulative deaths in the HIV-infected population, likewise, are profoundly affected. In the presence of an immature HIV epidemic failure to actively control MDRTB may result in approximately a third more deaths than if effective treatment is given. As the HIV epidemic matures then the impact of MDRTB grows substantially if MDRTB control strategies are ineffective. The epidemiological starting point for these scenarios is present in many regions within the former Soviet Union and this analysis suggests control of MDRTB should be an urgent priority.

What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents' smoking? Findings over a 15-year period.

PubMed

White, Victoria M; Warne, Charles D; Spittal, Matthew J; Durkin, Sarah; Purcell, Kate; Wakefield, Melanie A

2011-08-01

To assess the impact of tobacco control policies relating to youth access, clean indoor air and tobacco advertising at point-of-sale and outdoors, in addition to cigarette price and per capita tobacco control spending, on adolescent smoking prevalence. Repeated cross-sectional surveys. Logistic regression analyses examined association between policies and smoking prevalence. Australia, 1990-2005. A nationally representative sample of secondary students (aged 12-17 years) participating in a triennial survey (sample size per survey range: 20 560 to 27 480). Students' report of past-month smoking. In each jurisdiction, extent of implementation of the three policies for the year of the survey was determined. For each survey year, national per capita tobacco control spending was determined and jurisdiction-specific 12-month change in cigarette price obtained. Extent of implementation of the three policy areas varied between states and over the survey years. Multivariate analyses that adjusted for demographic factors, year and all tobacco control variables showed that 12-month cigarette price increases [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99], greater per capita tobacco control spending (OR: 0.99, 95% CI: 0.98-0.99) and stronger implementation of clean indoor air policies (OR: 0.93, 95% CI: 0.92-0.94) were associated with reduced smoking prevalence. Adult-directed, population-based tobacco control policies such as clean indoor air laws and increased prices of cigarettes, implemented as part of a well-funded comprehensive tobacco control programme are associated with lower adolescent smoking. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Leadership development and HIV/AIDS

PubMed Central

Szekeres, Greg; Coates, Thomas J.; Ehrhardt, Anke A.

2010-01-01

Leadership development among all sectors addressing HIV/AIDS has come to be recognized as a critically important endeavor as the HIV pandemic moves into its fourth decade. Globally, there is a tremendous need for well-trained leaders in healthcare, research, policy, programme management, activism and advocacy, especially in countries and settings with high HIV prevalence and limited human resource capacity. This article examines the growing need for HIV/AIDS leadership development, and describes and assesses a number of current initiatives that focus on leadership development in a variety of populations and settings. A series of recommendations are provided to expand the scope and impact of leadership development activities; recommendations are primarily targeted towards foundations and other funders and leadership development programme managers. PMID:18641465

Bridging Policy Implementation Gaps in Nigerian Education System: A Case Study of Universal Basic Education Programme in Cross River State, Nigeria

ERIC Educational Resources Information Center

Ogbiji, Joseph Etiongbie; Ogbiji, Sylvanus Achua

2016-01-01

This research focuses on identifying policy gaps in the implementation of Universal Basic Education (UBE) programme in Nigeria, with Cross River State being the study area. The three research questions used for the research center on the extent of the freeness of the UBE, the extent to which the programme has stimulated educational consciousness…

Integrating microfinance and health strategies: examining the evidence to inform policy and practice.

PubMed

Leatherman, Sheila; Metcalfe, Marcia; Geissler, Kimberley; Dunford, Christopher

2012-03-01

Single solutions continue to be inadequate in confronting the prevalent problems of poverty, ill health and insufficient health system capacity worldwide. The poor need access to an integrated set of financial and health services to have income security and better health. Over 3500 microfinance institutions (MFIs) provide microcredit and financial services to more than 155 million households worldwide. Conservative estimates indicate that at least 34 million of these households are very poor by the definition in the Millennium Development Goals, representing around 170 million people, many in remote areas beyond the reach of health agencies, both private and governmental. A small but increasing number of MFIs offer health-related services, such as education, clinical care, community health workers, health-financing and linkages to public and private health providers. Multiple studies indicate the effectiveness of microfinance and its impact on poverty. A small but growing number of studies also attempt to show that MFIs are capable of contributing to health improvement by increasing knowledge that leads to behavioural changes, and by enhancing access to health services through addressing financial, geographic and other barriers. While these studies are of uneven quality, they indicate positive health benefits in diverse areas such as maternal and child health, malaria and other infectious disease, and domestic violence. While more rigorous research is needed to inform policy and guide programme implementation to integrate microfinance and health interventions that can reliably enhance the well-being of the poor, there is useful evidence to support the design and delivery of integrated programmes now. Worldwide, current public health programmes and health systems are proving to be inadequate to meet population needs. The microfinance sector offers an underutilized opportunity for delivery of health-related services to many hard-to-reach populations.

An ethics training specific for European public health.

PubMed

Camps, Victoria; Hernández-Aguado, Ildefonso; Puyol, Angel; Segura, Andreu

2015-01-01

Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe's commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population's health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe.

India mental health country profile.

PubMed

Khandelwal, Sudhir K; Jhingan, Harsh P; Ramesh, S; Gupta, Rajesh K; Srivastava, Vinay K

2004-01-01

India, the second most populated country of the world with a population of 1.027 billion, is a country of contrasts. It is characterized as one of the world's largest industrial nations, yet most of the negative characteristics of poor and developing countries define India too. The population is predominantly rural, and 36% of people still live below poverty line. There is a continuous migration of rural people into urban slums creating major health and economic problems. India is one of the pioneer countries in health services planning with a focus on primary health care. Improvement in the health status of the population has been one of the major thrust areas for social development programmes in the country. However, only a small percentage of the total annual budget is spent on health. Mental health is part of the general health services, and carries no separate budget. The National Mental Health Programme serves practically as the mental health policy. Recently, there was an eight-fold increase in budget allocation for the National Mental Health Programme for the Tenth Five-Year Plan (2002-2007). India is a multicultural traditional society where people visit religious and traditional healers for general and mental health related problems. However, wherever modern health services are available, people do come forward. India has a number of public policy and judicial enactments, which may impact on mental health. These have tried to address the issues of stigma attached to the mental illnesses and the rights of mentally ill people in society. A large number of epidemiological surveys done in India on mental disorders have demonstrated the prevalence of mental morbidity in rural and urban areas of the country; these rates are comparable to global rates. Although India is well placed as far as trained manpower in general health services is concerned, the mental health trained personnel are quite limited, and these are mostly based in urban areas. Considering this, development of mental health services has been linked with general health services and primary health care. Training opportunities for various kinds of mental health personnel are gradually increasing in various academic institutions in the country and recently, there has been a major initiative in the growth of private psychiatric services to fill a vacuum that the public mental health services have been slow to address. A number of non-governmental organizations have also initiated activities related to rehabilitation programmes, human rights of mentally ill people, and school mental health programmes. Despite all these efforts and progress, a lot has still to be done towards all aspects of mental health care in India in respect of training, research, and provision of clinical services to promote mental health in all sections of society.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

PubMed

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages--unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers--as well as disadvantages--unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages – unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers – as well as disadvantages – unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance. PMID:19558682

When can the cause of a population decline be determined?

PubMed

Hefley, Trevor J; Hooten, Mevin B; Drake, John M; Russell, Robin E; Walsh, Daniel P

2016-11-01

Inferring the factors responsible for declines in abundance is a prerequisite to preventing the extinction of wild populations. Many of the policies and programmes intended to prevent extinctions operate on the assumption that the factors driving the decline of a population can be determined. Exogenous factors that cause declines in abundance can be statistically confounded with endogenous factors such as density dependence. To demonstrate the potential for confounding, we used an experiment where replicated populations were driven to extinction by gradually manipulating habitat quality. In many of the replicated populations, habitat quality and density dependence were confounded, which obscured causal inference. Our results show that confounding is likely to occur when the exogenous factors that are driving the decline change gradually over time. Our study has direct implications for wild populations, because many factors that could drive a population to extinction change gradually through time. © 2016 John Wiley & Sons Ltd/CNRS.

When can the cause of a population decline be determined?

USGS Publications Warehouse

Hefley, Trevor J.; Hooten, Mevin B.; Drake, John M.; Russell, Robin E.; Walsh, Daniel P.

2016-01-01

Inferring the factors responsible for declines in abundance is a prerequisite to preventing the extinction of wild populations. Many of the policies and programmes intended to prevent extinctions operate on the assumption that the factors driving the decline of a population can be determined. Exogenous factors that cause declines in abundance can be statistically confounded with endogenous factors such as density dependence. To demonstrate the potential for confounding, we used an experiment where replicated populations were driven to extinction by gradually manipulating habitat quality. In many of the replicated populations, habitat quality and density dependence were confounded, which obscured causal inference. Our results show that confounding is likely to occur when the exogenous factors that are driving the decline change gradually over time. Our study has direct implications for wild populations, because many factors that could drive a population to extinction change gradually through time.

Situational analysis of infant and young child nutrition policies and programmatic activities in the Islamic Republic of Mauritania.

PubMed

Wuehler, Sara E; El Hafed Ould Dehah, Cheikh Mohamed

2011-04-01

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs), so several international agencies joined to 'reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse, and interpret available information on infant and child feeding, and the nutrition and health situation of children <2 years of age in Mauritania as one of the six target countries (Burkina Faso, Chad, Mali, Mauritania, Niger, Senegal). These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November of 2008, key informants responsible for conducting IYCN-related activities in Mauritania were interviewed, and 46 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of human immunodeficiency virus (HIV), management of acute malnutrition, food security, and hygienic practices. Mauritania is on track to reaching the MDG of halving undernutrition among children <5 years of age by 2015. National policy documents, training guides, and programmes address nearly all of the key IYCN topics, specifically or generally. Exceptions are the use of zinc supplements in diarrhoea treatment, prevention of zinc deficiency, and dietary guidelines for preventing mother-to-child transmission of HIV. Substantial infrastructure capacity building was also recently implemented in nutritionally high-risk regions, and increases were reported in exclusive breastfeeding rates among children <6 months. The recent National Behaviour Change Communication Strategy is intended to address the needs of adapting programme activities to local needs. Despite these noteworthy accomplishments, the prevalence of acute malnutrition remains high, mortality rates did not decrease as malnutrition rates decreased, the overall prevalence of desirable nutrition-related practices is low, and human resources are reportedly insufficient to carry out all nutrition-related programme activities. Very little nutrition research has been conducted in Mauritania, and key informants identified gaps in adapting international programmes to local needs. Monitoring and evaluation reports have not been rigorous enough to identify which programme activities were implemented as designed or whether programmes were effective at improving nutritional and health status of young children. Therefore, we could not confirm which programmes might have been responsible for the reported improvements, or if other population-wide changes contributed to these changes. The policy framework is supportive of optimal IYCN practices, but greater resources and capacity building are needed to (i) support activities to adapt training materials and programme protocols to fit local needs, (ii) expand and track the implementation of evidence-based programmes nationally, (iii) improve and carry out monitoring and evaluation that identify effective and ineffective programmes, and (iv) apply these findings in developing, disseminating, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

From marginal to marginalised: The inclusion of men who have sex with men in global and national AIDS programmes and policy.

PubMed

McKay, Tara

2016-01-01

In the last decade, gay men and other men who have sex with men (msm) have come to the fore of global policy debates about AIDS prevention. In stark contrast to programmes and policy during the first two decades of the epidemic, which largely excluded msm outside of the Western countries, the Joint United Nations Programme on HIV/AIDS now identifies gay men and other msm as 'marginalized but not marginal' to the global response. Drawing on archival data and five waves of United Nations Country Progress Reports on HIV/AIDS (2001-2012), this paper examines the productive power of international organisations in the development and diffusion of the msm category, and considers how international organisations have shaped the interpretation of msm in national policies and programmes. These data show that the increasing separation of sexual identity and sexual behaviour at the global level helped to construct notions of risk and disease that were sufficiently broad to accommodate the diverse interests of global policy-makers, activists, and governments. However, as various international and national actors have attempted to develop prevention programmes for msm, the failure of the msm category to map onto lived experience is increasingly apparent.

Sustainable development, demography and sexual and reproductive health: inseparable linkages and their policy implications.

PubMed

Herrmann, Michael

2014-05-01

The greatest challenge today is to meet the needs of current and future generations, of a large and growing world population, without imposing catastrophic pressures on the natural environment. Meeting this challenge depends on decisive policy changes in three areas: more inclusive economic growth, greener economic growth, and population policies. This article focuses on efforts to address and harness demographic changes for sustainable development, which are largely outside the purview of the current debate. Efforts to this end must be based on the recognition that demographic changes are the cumulative result of individual choices and opportunities, and that demographic changes are best addressed through policies that enlarge these choices and opportunities, with a focus on ensuring unrestricted and universal access to sexual and reproductive health information and services, empowering women to fully participate in social, economic and political life, and investing in the education of the younger generation beyond the primary level. The article provides a strong argument for why the Programme of Action that was agreed at the International Conference on Population and Development (ICPD) 20 years ago continues to hold important implications and lessons for the formulation of the post-2015 development agenda, which is expected to supersede the Millennium Development Goals (MDGs). Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

PubMed

Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement.

South African HIV self-testing policy and guidance considerations.

PubMed

Venter, Francois; Majam, Mohammed; Jankelowitz, Lauren; Adams, Siraaj; Moorhouse, Michelle; Carmona, Sergio; Stevens, Wendy; Msimanga, Busisiwe R; Allen, David; Balani, Pooja; Nevhutalu, Zwoitwaho; Rhagnath, Naleni; Shroufi, Amir; Devillé, Walter; Kazangarare, Victoria; van der Wiel, Renee; Templeman, Hugo; Puren, Adrian; Tucker, Tim; van Cutsem, Gilles; Conradie, Francesca; Dong, Krista; Chidarikire, Thato; Gray, Andy

2017-01-01

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017-2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education.

Studying policy implementation using a macro, meso and micro frame analysis: the case of the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) programme nationally and in North West London.

PubMed

Caldwell, Sarah E M; Mays, Nicholas

2012-10-15

The publication of Best research for best health in 2006 and the "ring-fencing" of health research funding in England marked the start of a period of change for health research governance and the structure of research funding in England. One response to bridging the 'second translational gap' between research knowledge and clinical practice was the establishment of nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The goal of this paper is to assess how national-level understanding of the aims and objectives of the CLAHRCs translated into local implementation and practice in North West London. This study uses a variation of Goffman's frame analysis to trace the development of the initial national CLAHRC policy to its implementation at three levels. Data collection and analysis were qualitative through interviews, document analysis and embedded research. Analysis at the macro (national policy), meso (national programme) and micro (North West London) levels shows a significant common understanding of the aims and objectives of the policy and programme. Local level implementation in North West London was also consistent with these. The macro-meso-micro frame analysis is a useful way of studying the transition of a policy from high-level idea to programme in action. It could be used to identify differences at a local (micro) level in the implementation of multi-site programmes that would help understand differences in programme effectiveness.

Sexual diversity, social inclusion and HIV/AIDS.

PubMed

Cáceres, Carlos F; Aggleton, Peter; Galea, Jerome T

2008-08-01

Despite a number of programmes to prevent HIV among men who have sex with men (MSM) and, more generally, sexually diverse populations, gay and other homosexually active men continue to be at heightened risk of HIV and its consequences. This paper analyses some of the reasons for this situation and offers policy and programmatic recommendations to contribute to a solution. The social exclusion of MSM and transgender individuals is an overwhelming reality in the majority of countries worldwide. Although progress has been achieved in some countries, in most of the world the situation remains problematic. Present challenges to equality and to the realization of health, include the membership of groups or subcultures with high HIV prevalence, lower quality and coverage of services and programmes and the impact of higher-level influences such as laws, public policies, social norms and culture, which together configure an environment that is hostile to the integration and needs of certain groups. A social inclusion perspective on HIV prevention and AIDS-related care implies the adoption of strategies to understand and confront social vulnerability. Sexual exclusion intensifies the burden of HIV transmission and morbidity. As part of a comprehensive response there is an urgent need to: (i) improve our understanding of the characteristics and HIV burden among sexually diverse populations; (ii) creatively confront legal, social and cultural factors enhancing sexual exclusion; (iii) ensure the provision of broad-based and effective HIV prevention; (iv) offer adequate care and treatment; and (v) confront special challenges that characterize work with these populations in lower and middle-income countries.

Sexual diversity, social inclusion and HIV/AIDS

PubMed Central

Cáceres, Carlos F.; Aggleton, Peter; Galea, Jerome T.

2012-01-01

Despite a number of programmes to prevent HIV among men who have sex with men (MSM) and, more generally, sexually diverse populations, gay and other homosexually active men continue to be at heightened risk of HIV and its consequences. This paper analyses some of the reasons for this situation and offers policy and programmatic recommendations to contribute to a solution. The social exclusion of MSM and transgender individuals is an overwhelming reality in the majority of countries worldwide. Although progress has been achieved in some countries, in most of the world the situation remains problematic. Present challenges to equality and to the realization of health, include the membership of groups or subcultures with high HIV prevalence, lower quality and coverage of services and programmes and the impact of higher-level influences such as laws, public policies, social norms and culture, which together configure an environment that is hostile to the integration and needs of certain groups. A social inclusion perspective on HIV prevention and AIDS-related care implies the adoption of strategies to understand and confront social vulnerability. Sexual exclusion intensifies the burden of HIV transmission and morbidity. As part of a comprehensive response there is an urgent need to: (i) improve our understanding of the characteristics and HIV burden among sexually diverse populations; (ii) creatively confront legal, social and cultural factors enhancing sexual exclusion; (iii) ensure the provision of broad-based and effective HIV prevention; (iv) offer adequate care and treatment; and (v) confront special challenges that characterize work with these populations in lower and middle-income countries. PMID:18641469

The impact on healthcare, policy and practice from 36 multi-project research programmes: findings from two reviews.

PubMed

Hanney, Steve; Greenhalgh, Trisha; Blatch-Jones, Amanda; Glover, Matthew; Raftery, James

2017-03-28

We sought to analyse the impacts found, and the methods used, in a series of assessments of programmes and portfolios of health research consisting of multiple projects. We analysed a sample of 36 impact studies of multi-project research programmes, selected from a wider sample of impact studies included in two narrative systematic reviews published in 2007 and 2016. We included impact studies in which the individual projects in a programme had been assessed for wider impact, especially on policy or practice, and where findings had been described in such a way that allowed them to be collated and compared. Included programmes were highly diverse in terms of location (11 different countries plus two multi-country ones), number of component projects (8 to 178), nature of the programme, research field, mode of funding, time between completion and impact assessment, methods used to assess impact, and level of impact identified. Thirty-one studies reported on policy impact, 17 on clinician behaviour or informing clinical practice, three on a combined category such as policy and clinician impact, and 12 on wider elements of impact (health gain, patient benefit, improved care or other benefits to the healthcare system). In those multi-programme projects that assessed the respective categories, the percentage of projects that reported some impact was policy 35% (range 5-100%), practice 32% (10-69%), combined category 64% (60-67%), and health gain/health services 27% (6-48%). Variations in levels of impact achieved partly reflected differences in the types of programme, levels of collaboration with users, and methods and timing of impact assessment. Most commonly, principal investigators were surveyed; some studies involved desk research and some interviews with investigators and/or stakeholders. Most studies used a conceptual framework such as the Payback Framework. One study attempted to assess the monetary value of a research programme's health gain. The widespread impact reported for some multi-project programmes, including needs-led and collaborative ones, could potentially be used to promote further research funding. Moves towards greater standardisation of assessment methods could address existing inconsistencies and better inform strategic decisions about research investment; however, unresolved issues about such moves remain.

Why reduce health inequalities?

PubMed

Woodward, A; Kawachi, I

2000-12-01

It is well known that social, cultural and economic factors cause substantial inequalities in health. Should we strive to achieve a more even share of good health, beyond improving the average health status of the population? We examine four arguments for the reduction of health inequalities.1 Inequalities are unfair. Inequalities in health are undesirable to the extent that they are unfair, or unjust. Distinguishing between health inequalities and health inequities can be contentious. Our view is that inequalities become "unfair" when poor health is itself the consequence of an unjust distribution of the underlying social determinants of health (for example, unequal opportunities in education or employment).2 Inequalities affect everyone. Conditions that lead to marked health disparities are detrimental to all members of society. Some types of health inequalities have obvious spillover effects on the rest of society, for example, the spread of infectious diseases, the consequences of alcohol and drug misuse, or the occurrence of violence and crime.3 Inequalities are avoidable. Disparities in health are avoidable to the extent that they stem from identifiable policy options exercised by governments, such as tax policy, regulation of business and labour, welfare benefits and health care funding. It follows that health inequalities are, in principle, amenable to policy interventions. A government that cares about improving the health of the population ought therefore to incorporate considerations of the health impact of alternative options in its policy setting process.3 Interventions to reduce health inequalities are cost effective. Public health programmes that reduce health inequalities can also be cost effective. The case can be made to give priority to such programmes (for example, improving access to cervical cancer screening in low income women) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities have been formally evaluated using cost effectiveness analysis. We conclude that fairness is likely to be the most influential argument in favour of acting to reduce disparities in health, but the concept of equity is contested and susceptible to different interpretations. There is persuasive evidence for some outcomes that reducing inequalities will diminish "spill over" effects on the health of society at large. In principle, you would expect that differences in health status that are not biologically determined are avoidable. However, the mechanisms giving rise to inequalities are still imperfectly understood, and evidence remains to be gathered on the effectiveness of interventions to reduce such inequalities.

Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review.

PubMed

Leão, Teresa; Kunst, Anton E; Perelman, Julian

2018-02-01

Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association.

From Kothari Commission Report to Some Inputs for Draft National Education Policy 2016: An Attempt at Contextualizing Current Education Policymaking

ERIC Educational Resources Information Center

Tharakan, P. K. Michael

2017-01-01

The Subramanian Committee Report 2016 and the Some Inputs for Draft National Education Policy 2016 (SIDNEP 2016) are compared with its predecessors, the Kothari Commission Report 1964-1966 and the National Education Policy 1986 along with its Programme for Action 1986 and the revised Programme for Action 1992, to see how well its proposals are…

Estimated effect of alcohol pricing policies on health and health economic outcomes in England: an epidemiological model.

PubMed

Purshouse, Robin C; Meier, Petra S; Brennan, Alan; Taylor, Karl B; Rafia, Rachid

2010-04-17

Although pricing policies for alcohol are known to be effective, little is known about how specific interventions affect health-care costs and health-related quality-of-life outcomes for different types of drinkers. We assessed effects of alcohol pricing and promotion policy options in various population subgroups. We built an epidemiological mathematical model to appraise 18 pricing policies, with English data from the Expenditure and Food Survey and the General Household Survey for average and peak alcohol consumption. We used results from econometric analyses (256 own-price and cross-price elasticity estimates) to estimate effects of policies on alcohol consumption. We applied risk functions from systemic reviews and meta-analyses, or derived from attributable fractions, to model the effect of consumption changes on mortality and disease prevalence for 47 illnesses. General price increases were effective for reduction of consumption, health-care costs, and health-related quality of life losses in all population subgroups. Minimum pricing policies can maintain this level of effectiveness for harmful drinkers while reducing effects on consumer spending for moderate drinkers. Total bans of supermarket and off-license discounting are effective but banning only large discounts has little effect. Young adult drinkers aged 18-24 years are especially affected by policies that raise prices in pubs and bars. Minimum pricing policies and discounting restrictions might warrant further consideration because both strategies are estimated to reduce alcohol consumption, and related health harms and costs, with drinker spending increases targeting those who incur most harm. Policy Research Programme, UK Department of Health. Copyright 2010 Elsevier Ltd. All rights reserved.

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance

PubMed Central

Wolf, R Cameron; Adams, Darrin; Dayton, Robyn; Verster, Annette; Wong, Joe; Romero, Marcela; Mazin, Rafael; Settle, Edmund; Sladden, Tim; Keatley, JoAnne

2016-01-01

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools – supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups – provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now. PMID:27431472

Economic and health efficiency of education funding policy.

PubMed

Curtin, T R; Nelson, E A

1999-06-01

Public spending programmes to reduce poverty, expand primary education and improve the economic status of women are recommended priorities of aid agencies and are now gradually being reflected in third world governments' policies, in response to aid conditions imposed by the World Bank and OECD countries. However outcomes fall short of aspiration. This paper shows that donors' lending policies, especially those restricting public spending on education to the primary level, (1) perpetuate poverty, (2) minimise socio-economic impact of public health programmes and (3) prevent significant improvement in the economic status of women. These effects are the result of fundamental flaws in donors' education policy model. Evidence is presented to show that health status in developing countries will be significantly enhanced by increasing the proportion of the population which has at least post-primary education. Heads of households with just primary education have much the same probability of experiencing poverty and high mortality of their children as those with no education at all. Aid donors' policies, which require governments of developing countries to limit public funding of education to the primary level, have their roots in what is contended here to be an erroneous interpretation of human capital theory. This interpretation focuses only on the declining marginal internal rates of return on public investments in successive levels of schooling and ignores the opposite message of the increasing marginal net present values of those investments. Cars do not travel fastest in their lowest gear despite its fastest acceleration, life's long journey is not most comfortable for those with only primary schooling.

Current Status of the Milky Stork Re-introduction Programme in Malaysia and Its Challenges

PubMed Central

Ismail, Ahmad; Rahman, Faid

2016-01-01

This review discussed the current status of the Milky Stork Re-introduction Programme in Malaysia and the challenges it faced. Although it has continued for almost seven years, more challenges appeared as time elapsed mainly due to the arising conflicts between the implementation of conservation policy versus the development projects in Kuala Gula. Hence, the released population is struggling to adapt mainly due to the reduction of suitable habitat for nesting and disturbed foraging areas by the continuous anthropogenic activities. Furthermore, the lack of appropriate training among captive storks prior to being released also slows the adaptation of the birds in their new habitat. The increasing pattern of pollution in the area is also highlighted. Several suggestions were given to help improve the current re-introduction programme. These include improvements to the captive training method, improvement of the existing enclosure’s condition and environment, protection of remaining mangrove forest, creation of a buffer zone to mitigate the increasing pollution level in the area, close monitoring of the released population, and maintaining continuous support and awareness among the public. Considering the ongoing anthropogenic activities that may impair the status of Kuala Gula as an important bird sanctuary, emphasis should be given to achieve sustainable development throughout the area. PMID:27688848

Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?

PubMed Central

Mullan, Fitzhugh; Payne, Perry W; Ross, Heather

2010-01-01

Abstract Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include ”obligatory”, ”mandatory”, ”required” and ”requisite.” All these different programme names refer to a country’s law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals’ education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce. PMID:20461136

A political analysis of corporate drug donations: the example of Malarone in Kenya.

PubMed

Shretta, R; Walt, G; Brugha, R; Snow, R

2001-06-01

This paper describes the introduction of the Malarone Donation Programme in KENYA: Using a policy analysis approach it illustrates the political nature of donation programmes and how they are affected by a large and varied group of national, regional and international stakeholders, with different levels of influence and experience. The paper shows that interaction between these different groups may affect the development and implementation of the donation programme. It ends by raising some more general questions about public/private partnerships and corporate donation programmes, and their potential impact on national drug policies.

Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development

PubMed Central

Guhn, Martin; Janus, Magdalena; Enns, Jennifer; Brownell, Marni; Forer, Barry; Duku, Eric; Muhajarine, Nazeem; Raos, Rob

2016-01-01

Introduction Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health. Methods and analysis Canada-wide EDI records from 2004 to 2014 (representing over 700 000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends. Ethics and dissemination Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation. PMID:27130168

Studying policy implementation using a macro, meso and micro frame analysis: the case of the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) programme nationally and in North West London

PubMed Central

2012-01-01

Background The publication of Best research for best health in 2006 and the “ring-fencing” of health research funding in England marked the start of a period of change for health research governance and the structure of research funding in England. One response to bridging the ‘second translational gap’ between research knowledge and clinical practice was the establishment of nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The goal of this paper is to assess how national-level understanding of the aims and objectives of the CLAHRCs translated into local implementation and practice in North West London. Methods This study uses a variation of Goffman’s frame analysis to trace the development of the initial national CLAHRC policy to its implementation at three levels. Data collection and analysis were qualitative through interviews, document analysis and embedded research. Results Analysis at the macro (national policy), meso (national programme) and micro (North West London) levels shows a significant common understanding of the aims and objectives of the policy and programme. Local level implementation in North West London was also consistent with these. Conclusions The macro-meso-micro frame analysis is a useful way of studying the transition of a policy from high-level idea to programme in action. It could be used to identify differences at a local (micro) level in the implementation of multi-site programmes that would help understand differences in programme effectiveness. PMID:23067208

Integrating business continuity, emergency preparedness and emergency response: How these seemingly different disciplines can come together to make a comprehensive integrated programme.

PubMed

Halsne, Julia

2015-01-01

The East Bay Municipal Utility District provides potable water to approximately 1.3 million customers and treats wastewater for approximately 680,000 customers on the eastern side of San Francisco Bay in Northern California. Corporate policy requires the District to create and maintain an active emergency preparedness programme to manage its critical functions during an emergency and protect people, property and the environment. The policy also requires the District to create and maintain a business continuity programme to minimise disruptions of critical business functions and enhance its capability to recover operations. For these programmes to work effectively they must be coordinated. As the programmes at the District have evolved, the natural interrelationship, overlaps and integration have become inherent in their success. To ensure integration and coordination of these programmes, the District has developed management systems to effectively drive towards a seamless overarching programme.

The European Union Food Distribution programme for the Most Deprived Persons of the community, 1987-2013: From agricultural policy to social inclusion policy?

PubMed

Caraher, Martin

2015-07-01

The European Union Food Distribution programme for the Most Deprived Persons (MDP) of the community ran from 1987 until 2013. It was funded from Common Agricultural Policy budgets. The programme initially made use of surplus foods from the food mountains resulting from intervention stocks. This food was then distributed through aid agencies within member states, coordinated at a national government level. Reform of the CAP and global rises in food prices resulted in an increase in budget from €300 to €500 million Euros in 2010 with the added power to buy food on the open market. This led to a formal challenge to the scheme on the basis that buying goods on the open market shifted the emphasis from an agricultural/financial basis to a social one. A court ruling found that because the program was no longer used for removing surpluses the link to agriculture policy has become tenuous and therefore had no basis in community law. As a result of this legal challenge a number of policy compromises ensured the MDP would continue until the end of 2013 with a reduced budget. The scheme has been superseded by a new scheme in March 2014 called the Fund for European Aid to the Most Deprived (FEAD). This is seen as a social programme. The way that policy and politics developed and changed the MDP programme are set out. The article tracks its move from being an agricultural policy to a social welfare one. The key policy players and actors in this move are set out as are the changing context and policy frameworks. The replacement of the MDP by FEAD is discussed as is how intensive lobbying in 2012/13 resulted in the development of a new Fund for European Aid to the Most Deprived (FEAD). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Budget and financing of mental health services: baseline information on 89 countries from WHO's project atlas.

PubMed

Saxena, Shekhar; Sharan, Pratap; Saraceno, Benedetto

2003-09-01

Very little information is available on budget and financing of mental health services in the world. During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of drugs). The results showed that 32% of 191 countries did not have a specified budget for mental health. Of the 89 countries that supplied the requisite information 36% spent less than 1% of their total health budget on mental health. Many countries from Africa (79%) and the South East Asia (63%) were in this subgroup. Comparison with the Global Burden of Disease data showed a marked disparity between burden and resources. Lower income countries allocated a lesser proportion of their health budget on mental health in comparison to higher income countries. The primary method of financing mental health care in most countries was tax-based (60.2%), but many low-income countries depended on out-of-pocket expenditure (16.4%). The presence of mental health policies and programmes in general was not associated with the proportion of health budget allocated to mental health. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of policy on disability benefits and mental health resource indicators (beds, personnel, services for special populations and availability of drugs). Federal allocation for mental health care in most countries is low compared to the burden of these disorders. There is also a large disparity among countries and regions. Limitations of the study were, an exclusive reliance on government sources and the difficulty some governments faced in providing accurate information on federal mental health budget as it was not identified separately. To use resources more efficiently and judiciously, countries should support integration of services, reallocation of mental health beds, training in mental health to providers and services for special populations. Most countries need to increase their mental health budgets in order to provide necessary services. Countries with out-of-pocket payment as the primary method of mental health financing should seek to establish social insurance mechanisms. More research needs to be conducted to gather specific information on mental health financing in relation to policy and service planning.

Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?

PubMed

Shrimpton, Roger

2012-07-01

Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and Development of WHO through the Nutrition Guidance Expert Advisory Group processes. How and if programme guidance, as well as policy commitment for improved maternal nutrition, will be strengthened through the Nutrition Guidance Expert Advisory Group process is as yet unclear. The global movement to increase investment in programmes aimed at maternal and child undernutrition called Scaling Up Nutrition offers an opportunity to build developing country experience with efforts to improve nutrition during pregnancy and lactation. All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries. © 2012 Blackwell Publishing Ltd.

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

PubMed

Katz, Itamar; Glandon, Douglas; Wong, Wendy; Kargbo, Brima; Ombam, Regina; Singh, Shanti; Ramsammy, Leslie; Tal-Dia, Anta; Seck, Ibrahima; Osika, John S

2014-05-01

In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

Clinician-scientist MB/PhD training in the UK: a nationwide survey of medical school policy.

PubMed

Barnett-Vanes, Ashton; Ho, Guiyi; Cox, Timothy M

2015-12-30

This study surveyed all UK medical schools regarding their Bachelor of Medicine (MB), Doctor of Philosophy (PhD) (MB/PhD) training policy in order to map the current training landscape and to provide evidence for further research and policy development. Deans of all UK medical schools registered with the Medical Schools Council were invited to participate in this survey electronically. The number of medical schools that operate institutional MB/PhD programmes or permit self-directed student PhD intercalation. Medical school recruitment procedures and attitudes to policy guidance. 27 of 33 (81%) registered UK medical schools responded. Four (14%) offer an institutional MB/PhD programme. However, of those without institutional programmes, 17 (73%) permit study interruption and PhD intercalation: two do not (one of whom had discontinued their programme in 2013), three were unsure and one failed to answer the question. Regarding student eligibility, respondents cited high academic achievement in medical studies and a bachelor's or master's degree. Of the Medical schools without institutional MB/PhD programmes, 5 (21%) have intentions to establish a programme, 8 (34%) do not and 3 were unsure, seven did not answer. 19 medical schools (70%) considered national guidelines are needed for future MB/PhD programme development. We report the first national survey of MB/PhD training in the UK. Four medical schools have operational institutional MB/PhD programmes, with a further five intending to establish one. Most medical schools permit study interruption and PhD intercalation. The total number MB/PhD students yet to graduate from medical school could exceed 150, with 30 graduating per year. A majority of medical school respondents to this survey believe national guidelines are required for MB/PhD programme development and implementation. Further research should focus on the MB/PhD student experience. Discussion regarding local and national MB/PhD policies between medical schools and academic stakeholders are needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Lumping and splitting: the health policy agenda in India.

PubMed

Peters, David H; Rao, K Sujatha; Fryatt, Robert

2003-09-01

India's health system was designed in a different era, when expectations of the public and private sectors were quite different. India's population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing inter- and intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More 'splitting' of India's health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better 'lumping' of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments.

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.

PubMed

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-12-01

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

Assessment of Malawi’s success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

PubMed Central

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-01-01

Background Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. Methods We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. Results The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Conclusions Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality. PMID:26649176

'The Anglo-Saxon disease': a pilot study of the barriers to and facilitators of the use of randomised controlled trials of social programmes in an international context.

PubMed

Roberts, Helen; Petticrew, Mark; Liabo, Kristin; Macintyre, Sally

2012-11-01

There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value.

Scale is not an Issue : Opportunities for Collaboration among Geoscientists in Latin America and the Caribbean

NASA Astrophysics Data System (ADS)

Carby, B. E.

2015-12-01

Latin American and Caribbean (LAC) countries face multiple hazards such as earthquakes, volcanoes, accelerated erosion, landslides, drought, flooding, windstorms and the effects of climate variability and change. World Bank (2005) data indicate that seventeen of the top thirty-five countries with relatively high mortality risk from 3 or more hazards are located in LAC, El Salvador has the second highest per cent of its population at risk - 77.7% and 7 of the top 10 countries for population exposure to multiple hazards are in LAC. All LAC countries have half or more of GDP exposed to at least one hazard. The report underscores the need for better data and information on hazards and disasters to inform disaster risk reduction (DRR) and supports the view that reduction of disaster risk is essential for achieving Sustainable Development (SD). This suggests that DRR must be integrated into development planning of countries. However the Global Assessment Report notes that globally, there has been little progress in mainstreaming DRR in national development (UNISDR 2009). Without this, countries will not realise development goals. DRR efforts in LAC require an integrated approach including societal input in deciding priority DRR research themes and interdisciplinary, multi-hazard research informing DRR policy and practice. Jiminez (2015) from a study of countries across LAC reports that efforts are being made to link research to national planning through inclusion of policy makers in some university-led research projects. Research by the author in Jamaica reveals that the public sector has started to apply research on hazards to inform DRR policy, programmes and plans. As most research is done by universities, there is collaboration between the public sector and academia. Despite differences in scale among countries across the region, similarities in exposure to multiple hazards and potential hazard impacts suggest that collaboration among researchers in LAC could be beneficial. It is proposed here that this collaboration should go beyond the scientific community and should include sharing of experiences in linking DRR research to national development needs, inclusion of policy makers in research design and implementation and integration of research results in policy and programme development.

Invitation strategies and coverage in the population-based cancer screening programmes in the European Union.

PubMed

Vale, Diama B; Anttila, Ahti; Ponti, Antonio; Senore, Carlo; Sankaranaryanan, Rengaswamy; Ronco, Guglielmo; Segnan, Nereo; Tomatis, Mariano; Žakelj, Maja P; Elfström, Klara M; Lönnberg, Stefan; Dillner, Joakim; Basu, Partha

2018-03-21

The aim of this study was to describe the compliance of the population-based cancer screening programmes in the European Union Member States to the invitation strategies enumerated in the European Guidelines and the impact of such strategies on the invitational coverage. Experts in screening programme monitoring from the respective countries provided data. Coverage by invitation was calculated as the proportion of individuals in the target age range receiving a screening invitation over the total number of annualized eligible population. The invitation strategies of 30 breasts, 25 cervical and 27 colorectal national or regional population-based screening programmes are described. Individual mail invitations are sent by 28 breasts, 20 cervical and 25 colorectal screening programmes. Faecal occult blood test kits are sent by post in 17 of the colorectal cancer screening programmes. The majority of programmes claimed to have a population registry, although some use health insurance data as the database for sending invitations. At least 95% invitation coverage was reached by 16 breast, six cervical and five colorectal screening programmes. Majority of the programmes comply with the invitation strategies enumerated in the European guidelines, although there is still scope for improvements. Coverage by invitation is below the desirable level in many population-based cancer screening programmes in European Union.

"A Chance to Stand Back": Parenting Programmes for Parents of Adolescents

ERIC Educational Resources Information Center

Clarke, Karen; Churchill, Harriet

2012-01-01

Parenting interventions were an important feature of New Labour's policies to combat social exclusion. This paper critically examines parenting programmes for families with adolescents, assessing national and local policy aims against the perspectives of women who took part in a parenting course, which was the subject of a local evaluation. The…

Organic or Orchestrated: The Nature of Leadership in Rural Australia

ERIC Educational Resources Information Center

Davies, Amanda

2007-01-01

Over the last decade, rural leadership policies and programmes have attracted substantial support from all tiers of government. These policies are promulgated as a support mechanism for enhancing the internal capacity of rural communities to adjust to changes in the social and political-economic landscape. Leadership training programmes have been…

Policy and Practice of Pre-Service and In-Service Teacher Training Programmes and Facilities in Nigeria

ERIC Educational Resources Information Center

Oyebade, Stephen A.

2012-01-01

This paper reviewed policy provisions for "pre-service" and "in-service" teacher training programmes and facilities in Nigeria. It also presented reviews on legislations, agencies involved in teacher affairs management in Nigeria, using the historical and case study approach. Data on teaching qualifications of University of…

Tackling the Knowledge: Action Gap in Sustainable Consumption--Insights from a Participatory School Programme

ERIC Educational Resources Information Center

Barth, Matthias; Fischer, Daniel; Michelsen, Gerd; Nemnich, Claudia; Rode, Horst

2012-01-01

In the international policy discourse on sustainable consumption and production, education is acknowledged to be a powerful tool in changing unsustainable patterns of consumption. Current educational policies and programmes have responded to the consumption challenge mainly by including and addressing consumption issues in formal tuition in…

Unintentional injury mortality among indigenous communities of Taiwan: trends from 2002 to 2013 and evaluation of a community-based intervention.

PubMed

Pan, Stephen W; Chong, Hiu Ha; Kao, Hui-Chuan

2017-11-27

Indigenous communities in Taiwan shoulder a disproportionate burden of unintentional injury fatalities. We compare unintentional injury mortality rate trends among Taiwan's indigenous communities and the general population from 2002 to 2013, and evaluate potential impact of a community-based injury prevention programme on indigenous unintentional injury death rates. Standardised and crude unintentional injury mortality rates were obtained from Taiwan government reports. Segmented linear regression was used to estimate and compare unintentional injury mortality rate trends before and after the intervention. Between 2002 and 2013, unintentional injury mortality rates among Taiwan's indigenous population significantly declined by about 4.5 deaths per 100 000 each year (p<0.0001). During that time, the unintentional injury mortality rate ratio between indigenous Taiwanese and the general population significantly decreased by approximately 1% each successive year (p=0.02). However, we were unable to detect evidence that the 'Healthy and Safe Tribe' programme was associated with a statistically significant decrease in the unintentional injury mortality rate trend among indigenous persons (p=0.81). Taiwanese indigenous communities remain at significantly higher risk of unintentional injury death, though the gap may be slowly narrowing. We found no evidence that the 'Healthy and Safe Tribe' indigenous injury-prevention programme significantly contributed to the nationwide decline in unintentional injury mortality among indigenous Taiwanese communities from 2009 to 2013. Future interventions to address the disproportionate burden of unintentional injury fatalities among indigenous Taiwanese should consider interventions with wider coverage of the indigenous population, and complementing grass roots led community-based interventions with structural policy interventions as well. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes?

PubMed

Wu, Shishi; Legido-Quigley, Helena; Spencer, Julia; Coker, Richard James; Khan, Mishal Sameer

2018-02-23

In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

PubMed

Stewart, M J; Neufeld, A; Harrison, M J; Spitzer, D; Hughes, K; Makwarimba, E

2006-07-01

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Relaunch of the official community health worker programme in Mozambique: is there a sustainable basis for iCCM policy?

PubMed

Chilundo, Baltazar Gm; Cliff, Julie L; Mariano, Alda Re; Rodríguez, Daniela C; George, Asha

2015-12-01

In Mozambique, integrated community case management (iCCM) of diarrhoea, malaria and pneumonia is embedded in the national community health worker (CHW) programme, mainstreaming it into government policy and service delivery. Since its inception in 1978, the CHW programme has functioned unevenly, was suspended in 1989, but relaunched in 2010. To assess the long-term success of iCCM in Mozambique, this article addresses whether the current CHW programme exhibits characteristics that facilitate or impede its sustainability. We undertook a qualitative case study based on document review (n = 54) and key informant interviews (n = 21) with respondents from the Ministry of Health (MOH), multilateral and bilateral agencies and non-governmental organizations (NGOs) in Maputo in 2012. Interviews were mostly undertaken in Portuguese and all were coded using NVivo. A sustainability framework guided thematic analysis according to nine domains: strategic planning, organizational capacity, programme adaptation, programme monitoring and evaluation, communications, funding stability, political support, partnerships and public health impact. Government commitment was high, with the MOH leading a consultative process in Maputo and facilitating successful technical coordination. The MOH made strategic decisions to pay CHWs, authorize their prescribing abilities, foster guidance development, support operational planning and incorporate previously excluded 'old' CHWs. Nonetheless, policy negotiations excluded certain key actors and uncertainty remains about CHW integration into the civil service and their long-term retention. In addition, reliance on NGOs and donor funding has led to geographic distortions in scaling up, alongside challenges in harmonization. Finally, dependence on external funding, when both external and government funding are declining, may hamper sustainability. Our analysis represents a nuanced assessment of the various domains that influence CHW programme sustainability, highlighting strategic areas such as CHW payment and programme financing. These organizational and contextual determinants of sustainability are central to CHW programme strengthening and iCCM policy support. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Relaunch of the official community health worker programme in Mozambique: is there a sustainable basis for iCCM policy?

PubMed Central

Chilundo, Baltazar GM; Cliff, Julie L; Mariano, Alda RE; Rodríguez, Daniela C; George, Asha

2015-01-01

Background: In Mozambique, integrated community case management (iCCM) of diarrhoea, malaria and pneumonia is embedded in the national community health worker (CHW) programme, mainstreaming it into government policy and service delivery. Since its inception in 1978, the CHW programme has functioned unevenly, was suspended in 1989, but relaunched in 2010. To assess the long-term success of iCCM in Mozambique, this article addresses whether the current CHW programme exhibits characteristics that facilitate or impede its sustainability. Methodology: We undertook a qualitative case study based on document review (n = 54) and key informant interviews (n = 21) with respondents from the Ministry of Health (MOH), multilateral and bilateral agencies and non-governmental organizations (NGOs) in Maputo in 2012. Interviews were mostly undertaken in Portuguese and all were coded using NVivo. A sustainability framework guided thematic analysis according to nine domains: strategic planning, organizational capacity, programme adaptation, programme monitoring and evaluation, communications, funding stability, political support, partnerships and public health impact. Results: Government commitment was high, with the MOH leading a consultative process in Maputo and facilitating successful technical coordination. The MOH made strategic decisions to pay CHWs, authorize their prescribing abilities, foster guidance development, support operational planning and incorporate previously excluded ‘old’ CHWs. Nonetheless, policy negotiations excluded certain key actors and uncertainty remains about CHW integration into the civil service and their long-term retention. In addition, reliance on NGOs and donor funding has led to geographic distortions in scaling up, alongside challenges in harmonization. Finally, dependence on external funding, when both external and government funding are declining, may hamper sustainability. Conclusions: Our analysis represents a nuanced assessment of the various domains that influence CHW programme sustainability, highlighting strategic areas such as CHW payment and programme financing. These organizational and contextual determinants of sustainability are central to CHW programme strengthening and iCCM policy support. PMID:26516151

Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based faecal occult blood testing, faecal immunochemical testing and flexible sigmoidoscopy

PubMed Central

Sharp, L; Tilson, L; Whyte, S; O'Ceilleachair, A; Walsh, C; Usher, C; Tappenden, P; Chilcott, J; Staines, A; Barry, M; Comber, H

2012-01-01

Background: Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55–74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55–74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60. Methods: A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken. Results: All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening €589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT (€1696) and gFOBT (€4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates. Conclusion: Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers. PMID:22343624

Policy and stakeholder analysis of infant and young child feeding programmes in Sri Lanka.

PubMed

Godakandage, Sanjeeva S P; Senarath, Upul; Jayawickrama, Hiranya S; Siriwardena, Indika; Wickramasinghe, S W A D A; Arumapperuma, Prasantha; Ihalagama, Sathyajith; Nimalan, Srisothinathan; Archchuna, Ramanathan; Umesh, Claudio; Uddin, Shahadat; Thow, Anne Marie

2017-06-13

Infant and young child feeding practices (IYCF) play a critical role in growth and development of children. A favourable environment supported by appropriate policies and positive contributions from all stakeholders are prerequisites for achieving optimal IYCF practices. This study aimed to assess the IYCF-related policy environment and role of stakeholders in policy making in Sri Lanka, in order to identify opportunities to strengthen the policy environment to better support appropriate IYCF and reduce childhood malnutrition. We mapped national level policy-related documents on IYCF, and conducted a stakeholder analysis of IYCF policy making. A matrix was designed to capture data from IYCF policy-related documents using a thematic approach. A narrative synthesis of data from different documents was conducted to achieve the first objective. We then conducted an analysis of technical and funding links of stakeholders who shape IYCF policies and programmes in Sri Lanka using the Net-Map technique, to achieve the second objective. A total of 35 respondents were purposively selected based on their knowledge on the topic, and individual interviews were conducted. Twenty four policies were identified that contained provisions in line with global recommendations for best-practice IYCF, marketing of breast milk substitutes, strengthening health and non-health systems, maternity benefits, inter-sectoral collaboration, capacity building, health education and supplementation. However, there is no separate, written policy on IYCF in Sri Lanka. Participants identified 56 actors involved in shaping IYCF policies and programmes through technical support, and 36 through funding support. The Government Health Sector was the most connected as well as influential, followed by development partners. Almost all actors in the networks were supportive for IYCF policies and programmes. All evidence-based recommendations are covered in related policies. However, advocacy should be targeted towards strategic support for IYCF in high-level policy documents. The stakeholder analysis confirmed a network led by the government health sector. Enhancing the multi-sectoral commitments stressed in policy documents is an opportunity to strengthen IYCF policy process in Sri Lanka.

Collaborative Doctoral Programmes: Employer Engagement, Knowledge Mediation and Skills for Innovation

ERIC Educational Resources Information Center

Kitagawa, Fumi

2014-01-01

This paper investigates forms of collaborative doctoral programmes that enable employer engagement in innovation and skills development. Collaborative doctoral programmes exist in different national contexts for the development of the science and technology human capital. Such programmes are also seen as policy tools that enhance relationships…

Programme costs in the economic evaluation of health interventions

PubMed Central

Johns, Benjamin; Baltussen, Rob; Hutubessy, Raymond

2003-01-01

Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting. Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered. This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions. PMID:12773220

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

PubMed

de Andrade, Luiz Odorico Monteiro; Pellegrini Filho, Alberto; Solar, Orielle; Rígoli, Félix; de Salazar, Lígia Malagon; Serrate, Pastor Castell-Florit; Ribeiro, Kelen Gomes; Koller, Theadora Swift; Cruz, Fernanda Natasha Bravo; Atun, Rifat

2015-04-04

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Programme and policy options for preventing obesity in China.

PubMed

Wang, H; Zhai, F

2013-11-01

By 2002, China's prevalence of overweight and obesity among adults was 18.9 and 2.9%, respectively. The replacement of traditional Chinese diet with 'Western diet', major declines in all phases of activity and increased sedentary activity are cited as the main reasons explaining the rapid increase in overweight and obesity, which bring major economic and health costs. The Nutrition Improvement Work Management Approach was released in 2010. Overweight and obesity prevention-related policies were added to national planning for disease prevention and control. The Guidelines for Prevention and Control of Overweight and Obesity of Chinese Adults and the School-age Children and Teenagers Overweight and Obesity Prevention and Control Guidelines in China were promulgated in 2003 and 2007, respectively. Few education programmes have been implemented. Selected academic intervention research projects dominate with a focus on reducing child obesity and promoting healthier diets; increasing physical activity and reducing sedentary time; and facilitating changes in family, school, social and cultural environments. Intervention samples are small and have not addressed the increasing rates of obesity throughout the entire population. Government provision of effective policy measures, multisectoral cooperation and increasing corporate social responsibility are keys to curbing the trend towards overweight and obesity in China. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Nutrition of children and women in Bangladesh: trends and directions for the future.

PubMed

Ahmed, Tahmeed; Mahfuz, Mustafa; Ireen, Santhia; Ahmed, A M Shamsir; Rahman, Sabuktagin; Islam, M Munirul; Alam, Nurul; Hossain, M Iqbal; Rahman, S M Mustafizur; Ali, M Mohsin; Choudhury, Fatima Perveen; Cravioto, Alejandro

2012-03-01

Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations' Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.

Nutrition of Children and Women in Bangladesh: Trends and Directions for the Future

PubMed Central

Mahfuz, Mustafa; Ireen, Santhia; Ahmed, A.M. Shamsir; Rahman, Sabuktagin; Islam, M. Munirul; Alam, Nurul; Hossain, M. Iqbal; Rahman, S.M. Mustafizur; Ali, M. Mohsin; Choudhury, Fatima Perveen; Cravioto, Alejandro

2012-01-01

Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations’ Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized. PMID:22524113

The National Institute for Health Research Leadership Programme

PubMed Central

Jones, Molly Morgan; Wamae, Watu; Fry, Caroline Viola; Kennie, Tom; Chataway, Joanna

2012-01-01

Abstract RAND Europe evaluated the National Institute for Health Research (NIHR) Leadership Programme in an effort to help the English Department of Health consider the extent to which the programme has helped to foster NIHR's aims, extract lessons for the future, and develop plans for the next phase of the leadership programme. Successful delivery of high-quality health research requires not only an effective research base, but also a system of leadership supporting it. However, research leaders are not often given the opportunity, nor do they have the time, to attend formal leadership or management training programmes. This is unfortunate because research has shown that leadership training can have a hugely beneficial effect on an organisation. Therefore, the evaluation has a particular interest in understanding the role of the programme as a science policy intervention and will use its expertise in science policy analysis to consider this element alongside other, more traditional, measures of evaluation. PMID:28083231

Translating evidence into policy for cardiovascular disease control in India

PubMed Central

2011-01-01

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care. PMID:21306620

South African HIV self-testing policy and guidance considerations

PubMed Central

Jankelowitz, Lauren; Adams, Siraaj; Msimanga, Busisiwe R.; Nevhutalu, Zwoitwaho; Rhagnath, Naleni; Shroufi, Amir; Devillé, Walter; Kazangarare, Victoria; van der Wiel, Renee; Templeman, Hugo; Conradie, Francesca; Chidarikire, Thato; Gray, Andy

2017-01-01

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017–2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education. PMID:29568643

Preventing domestic abuse for children and young people: A review of school-based interventions.

PubMed

Stanley, Nicky; Ellis, Jane; Farrelly, Nicola; Hollinghurst, Sandra; Downe, Soo

2015-12-01

Schools provide the setting in which interventions aimed at preventing intimate partner violence and abuse (IPVA) are delivered to young people in the general population and a range of programmes have been designed and evaluated. To date, most rigorous studies have been undertaken in North America and the extent to which programmes are transferable to other settings and cultures is uncertain. This paper reports on a mixed methods review, aimed at informing UK practise and policy, which included a systematic review of the international literature, a review of the UK grey literature and consultation with young people as well as experts to address the question of what works for whom in what circumstances. The context in which an intervention was delivered was found to be crucial. Context included: the wider policy setting; the national or regional level, where the local culture shaped understandings of IPVA, and the readiness of an individual school. The programmes included in the systematic review provided stronger evidence for changing knowledge and attitudes than for behavioural change and those young people who were at higher risk at baseline may have exerted a strong influence on study outcomes. Shifting social norms in the peer group emerged as a key mechanism of change and the young people consulted emphasised the importance of authenticity which could be achieved through the use of drama and which required those delivering programmes to have relevant expertise. While the consultation identified increasing interest in targeting interventions on boys, there was an identified lack of materials designed for minority groups of young people, especially Lesbian, Gay, Bisexual and Transgender young people. Increased responsivity to the local context can be achieved by involving those who will deliver and receive these preventive programmes in their development. Schools need to be better prepared and supported in the task of delivering these interventions and this is particularly relevant for the management of disclosures of IPVA. Outcomes measured by evaluations should include those relevant to education.

Preventing domestic abuse for children and young people: A review of school-based interventions

PubMed Central

Stanley, Nicky; Ellis, Jane; Farrelly, Nicola; Hollinghurst, Sandra; Downe, Soo

2015-01-01

Schools provide the setting in which interventions aimed at preventing intimate partner violence and abuse (IPVA) are delivered to young people in the general population and a range of programmes have been designed and evaluated. To date, most rigorous studies have been undertaken in North America and the extent to which programmes are transferable to other settings and cultures is uncertain. This paper reports on a mixed methods review, aimed at informing UK practise and policy, which included a systematic review of the international literature, a review of the UK grey literature and consultation with young people as well as experts to address the question of what works for whom in what circumstances. The context in which an intervention was delivered was found to be crucial. Context included: the wider policy setting; the national or regional level, where the local culture shaped understandings of IPVA, and the readiness of an individual school. The programmes included in the systematic review provided stronger evidence for changing knowledge and attitudes than for behavioural change and those young people who were at higher risk at baseline may have exerted a strong influence on study outcomes. Shifting social norms in the peer group emerged as a key mechanism of change and the young people consulted emphasised the importance of authenticity which could be achieved through the use of drama and which required those delivering programmes to have relevant expertise. While the consultation identified increasing interest in targeting interventions on boys, there was an identified lack of materials designed for minority groups of young people, especially Lesbian, Gay, Bisexual and Transgender young people. Increased responsivity to the local context can be achieved by involving those who will deliver and receive these preventive programmes in their development. Schools need to be better prepared and supported in the task of delivering these interventions and this is particularly relevant for the management of disclosures of IPVA. Outcomes measured by evaluations should include those relevant to education. PMID:26740731

Spatial access disparities to primary health care in rural and remote Australia.

PubMed

McGrail, Matthew Richard; Humphreys, John Stirling

2015-11-04

Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia

PubMed Central

Mahendradhata, Yodi; Probandari, Ari; Widjanarko, Bagoes; Riono, Pandu; Mustikawati, Dyah; Tiemersma, Edine W.; Alisjahbana, Bachti

2014-01-01

There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme. PMID:25361728

In-Service Training Programmes for Mathematics Teachers Nested in Transnational Policy Discourses

ERIC Educational Resources Information Center

Erixon, Eva-Lena; Wahlström, Ninni

2016-01-01

Results in mathematics on international knowledge surveys like Programme for International Student Assessment and Trends in International Mathematics and Science Study have become one of the most important factors for the perceived success or failure of schools and even entire education systems in the policy arena. In this article, we explore the…

Educational Policies/Programmes' Effect on Attrition Rates in Primary Schools in Nigeria

ERIC Educational Resources Information Center

Duze, Chinelo O.

2012-01-01

This paper examined attrition in primary schools in Nigeria with specific reference and focus on some policies and programmes of Nigeria's educational system with a view to highlighting its possible effect on the attainment of the Education for All (EFA) goals by 2015. It reviewed equal educational opportunity in relation to school environments…

Factors Affecting the Impact of Teacher Education Programmes on Teacher Preparedness: Implications for Accreditation Policy

ERIC Educational Resources Information Center

Ingvarson, Lawrence; Beavis, Adrian; Kleinhenz, Elizabeth

2007-01-01

The purpose of this study was to provide guidance to policy-makers about the standards that might be appropriate for accrediting teacher education programmes. The study was commissioned by the Victorian Institute of Teaching (VIT), a statutory body established in 2001 by the Victorian state government with responsibility for the registration…

Positive discrimination in education: Its justification and a Chilean example

NASA Astrophysics Data System (ADS)

Garcia-Huidobro, Juan Eduardo S.

1994-05-01

Educational policies in Latin America have centred on two main issues: raising the quality of education, and improving the equity of its distribution. Access to schooling was until recently at the heart of the debate, the degree of justice of the educational systems being measured by their capacity to enrol and retain the population. Attention is now concentrated on the strength of the cultural resources offered by schools and the effectiveness of provision. Learning is the priority of education policy. This article develops the theme of equity, examining the concept and describing a programme which focuses on improving the equity of the Chilean educational system. It is suggested that educational equity should no longer mean equality of access but equality of results. A just system therefore needs to concentrate on raising the quality of schools serving the poorest sectors of society. The Chilean "900 Schools Programme" is an example. Its aim was to raise levels of achievement by improving the learning of poor children from 1st to 4th grade in reading, writing and mathematics. To do so, it improved the school environment, textbooks and methodologies, and offered support to children outside school hours by the work of community monitors.

Problems of cost recovery implementation in district health care: a case study from Niger.

PubMed

Meuwissen, Liesbeth Emm

2002-09-01

This article describes and analyzes the impact of the introduction of a cost recovery system in 11 health centres of Tillabéri district, Niger, West Africa, between August 1997 and August 1999. The study is based on data collected by the health workers, observations of district activities and policy meetings and literature from similar programmes in the region. The central question addressed by this article is why a well-formulated programme, which was implemented accordingly, failed to succeed. The system described fits within the national health policy framework in Niger, which opted to introduce fixed attendance fees in health centres. The system was introduced as a part of a comprehensive package to improve the accessibility, quality and organization of the districts' health care. Discussed are the problems encountered in the functioning of the system, such as the unpredictability of the cost recovery rate, the drop in patients' attendance and the undermining effect of serious and regular shortages of essential generic drugs at the wholesale dealer. Further discussed are the supervision and control of the financial and drug administration and the participation of the population, which are identified as key areas of interest for sustainability of any cost recovery system.

The Global Opioid Policy Initiative: a wealth of information, but what is next?

PubMed

Scholten, Willem

2014-03-01

Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. Data from the project will be an important resource for those who advocate for improved access to opioid analgesics. Yet, like so often, many more aspects of inadequate opioid analgesic consumption require exploration and reporting, including legislative barriers. The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.

Transcalar networks for policy transfer and implementation: the case of global health policies for malaria and HIV/AIDS in Cameroon.

PubMed

Ngoasong, Michael Zisuh

2011-01-01

This paper explores the nature and type of policy transfer promoted by global health partnerships to facilitate access to medication in Cameroon and the associated implementation challenges. Using concepts from policy transfer, multi-level governance and the politics of scale, the paper conceptualizes the social spaces (global-national-local linkages) through which global health policies are negotiated as transcalar networks. The framework is used to analyse policy documents, technical and media reports and journal articles focusing on two global health partnerships (GHPs)-Roll Back Malaria and the Accelerating Access Initiative-in Cameroon. Both GHPs helped to create the national Malaria and HIV/AIDS programmes in Cameroon, respectively. Global policies are negotiated through dialogue processes involving global, national and local partners who constitute the national HIV/AIDS and malaria committees. Successful policy transfer is evident from the consensual nature of decision-making. Analysis of policy implementation reveals that GHPs offer a 'technical fix' based on specific medical intervention programmes with a relatively limited focus on disease prevention. The GHP approach imposes new governance challenges due to policy resistance strategies (strategic interests of international agencies and country-specific challenges). Evidence of this is seen in the existence of several overlapping programmes and initiatives that distort accountability and governance mechanisms defined by the national committees. Finally, the implications of these challenges for achieving access to medication are discussed.

Translating childhood tuberculosis case management research into operational policies.

PubMed

Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O

2011-08-01

The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

Dietary guidelines in singapore.

PubMed

Lee, Benjamin Lc

2011-01-01

The 2011 Dietary Guidelines were developed with the aim of providing guidance on what dietary strategies can best address increasing rates of obesity and non-communicable chronic disease in Singapore. This set of dietary guidelines was developed with a local expert committee based on a review of scientific literature and data on current dietary patterns from the 2010 National Nutrition Survey. Projected nutrient intakes from a diet adhering to the 2011 Dietary Guidelines were calculated using a local food composition database (FOCOS) and validated against nutrient recommendations. Acknowledging that dietary requirements differ between age groups, different sets of dietary guidelines have been developed and customised for different segments of the population. To date, Singapore has produced dietary guidelines for children and adolescents (focusing on establishing healthy lifelong eating patterns), adults (focusing on preventing obesity and reinforcing healthy eating patterns), and most recently, guidelines for older adults (>50 years of age) that address the issue of potential dietary insufficiency caused by age-related increases in nutrient requirements combined with a reduction in energy requirements. In Singapore, dietary guidelines have been used to inform and direct public policy and promote dietary patterns that meet nutrient requirements while reducing the risk of non-communicable chronic diseases. Examples of public policy include: national guidelines on food advertising and standards for food served in nursing homes; examples of public health promotion programmes include: the Healthier Choice Symbol Programme for packaged food products and programmes encouraging provision of healthier meals in hawker centres, restaurants, and school or workplace canteens.

Ageing with elegans: a research proposal to map healthspan pathways.

PubMed

Luyten, Walter; Antal, Peter; Braeckman, Bart P; Bundy, Jake; Cirulli, Francesca; Fang-Yen, Christopher; Fuellen, Georg; Leroi, Armand; Liu, Qingfei; Martorell, Patricia; Metspalu, Andres; Perola, Markus; Ristow, Michael; Saul, Nadine; Schoofs, Liliane; Siems, Karsten; Temmerman, Liesbet; Smets, Tina; Wolk, Alicja; Rattan, Suresh I S

2016-08-01

Human longevity continues to increase world-wide, often accompanied by decreasing birth rates. As a larger fraction of the population thus gets older, the number of people suffering from disease or disability increases dramatically, presenting a major societal challenge. Healthy ageing has therefore been selected by EU policy makers as an important priority ( http://www.healthyageing.eu/european-policies-and-initiatives ); it benefits not only the elderly but also their direct environment and broader society, as well as the economy. The theme of healthy ageing figures prominently in the Horizon 2020 programme ( https://ec.europa.eu/programmes/horizon2020/en/h2020-section/health-demographic-change-and-wellbeing ), which has launched several research and innovation actions (RIA), like "Understanding health, ageing and disease: determinants, risk factors and pathways" in the work programme on "Personalising healthcare" ( https://ec.europa.eu/research/participants/portal/desktop/en/opportunities/h2020/topics/693-phc-01-2014.html ). Here we present our research proposal entitled "ageing with elegans" (AwE) ( http://www.h2020awe.eu/ ), funded by this RIA, which aims for better understanding of the factors causing health and disease in ageing, and to develop evidence-based prevention, diagnostic, therapeutic and other strategies. The aim of this article, authored by the principal investigators of the 17 collaborating teams, is to describe briefly the rationale, aims, strategies and work packages of AwE for the purposes of sharing our ideas and plans with the biogerontological community in order to invite scientific feedback, suggestions, and criticism.

Aging in Asia: a cultural, socio-economical and historical perspective.

PubMed

Goh, Victor H H

2005-06-01

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no "single size fits all" solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.

How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework.

PubMed

Burstrom, Bo; Nylen, Lotta; Clayton, Stephen; Whitehead, Margaret

2011-01-01

Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and (2) whether the outcomes vary for different groups in the population. Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and socio-demographic groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact with experts in the field, for the period 1990-2009. A total of 11 studies were included in the final review, six of which addressed review question (1) and seven addressed review question (2). All the six observational studies of access reported biased selection into vocational rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income, employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for successful outcomes, but success also depended on the state of the local labour market. There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of impact results.

Consensus builds on population policy as ICPD PrepCom meetings conclude. Vatican objections firm and vocal.

PubMed

1994-04-29

In April, 1994, at UN headquarters in New York, delegates from almost 200 countries and nongovernmental organizations (NGOs) negotiated a Programme of Action to be ratified following more debate at the International Conference on Population and Development in Cairo in September. A sizable consensus emerged for this Preparatory Committee III (PrepCom) meeting. It has an expanded view of population policy that centers more on meeting individual needs and less on achieving strict demographic goals. Thus, it focuses on the unmet need for reproductive health services (family planning, basic women's health care, and services linked to sexually transmitted diseases). It considers women's status and female education as being important themselves as well as key determinants of fertility rates. Disagreement over access to abortion services and reproductive health services for adolescents remain. Unlike earlier world conferences, most of the world is working towards a consensus, while the Vatican and just a few small countries (Benin, Malta, Honduras, and Nicaragua) object to these services. Some topics that US National Conference of Catholic Bishops did not want in the Programme of Action were references to reducing the incidence of unsafe abortion, promoting condom use to prevent HIV/AIDS, and even safe motherhood. The US and Japan have committed sizable increases in population assistance. Some European countries are concerned about how their contributions would be allocated. US Undersecretary for Global Affairs and a mostly female 23-member US delegation attended PrepCom III. Most of the US delegates were from NGOs. Many country delegates were women. Many countries accepted recommendations of the women's caucus. The US's priorities are promotion of universal access to the full range of high quality family planning and reproductive health services; increasing women's status; child survival promotion; serving adolescent needs; augmenting the role and responsibility of men in reproductive health; strengthening the family; and sustainable development.

[Methods for health impact assessment of policies for municipal solid waste management: the SESPIR Project].

PubMed

Parmagnani, Federica; Ranzi, Andrea; Ancona, Carla; Angelini, Paola; Chiusolo, Monica; Cadum, Ennio; Lauriola, Paolo; Forastiere, Francesco

2014-01-01

The Project Epidemiological Surveillance of Health Status of Resident Population Around the Waste Treatment Plants (SESPIR) included five Italian regions (Emilia-Romagna, Piedmont, Lazio, Campania, and Sicily) and the National Institute of Health in the period 2010-2013. SESPIR was funded by the Ministry of Health as part of the National centre for diseases prevention and control (CCM) programme of 2010 with the general objective to provide methods and operational tools for the implementation of surveillance systems for waste and health, aimed at assessing the impact of the municipal solid waste (MSW) treatment cycle on the health of the population. The specific objective was to assess health impacts resulting from the presence of disposal facilities related to different regional scenarios of waste management. Suitable tools for analysis of integrated assessment of environmental and health impact were developed and applied, using current demographic, environmental and health data. In this article, the methodology used for the quantitative estimation of the impact on the health of populations living nearby incinerators, landfills and mechanical biological treatment plants is showed, as well as the analysis of three different temporal scenarios: the first related to the existing plants in the period 2008-2009 (baseline), the second based on regional plans, the latter referring to MSW virtuous policy management based on reduction of produced waste and an intense recovery policy.

The need for youth-oriented policies and programmes on responsible sexuality in Argentina.

PubMed

Mercer, R; Ramos, S; Szulik, D; Zamberlin, N

2001-05-01

Since the mid-1990s, several provincial bills have been passed in Argentina mandating the creation of programmes for family planning and sexual health services and education. A National Plan for Integrated Health Care for Adolescents was also passed but resources and actual programmes remain limited. The policy process has been fraught with difficulties, owing to a strong alliance between the State and the Catholic church. Provision of contraceptives to adolescents has been one of the most contentious issues, as adolescents are legally minors and need parental permission to use family planning. NGOs are working with young people to help them to voice their perspectives and demands. The Programme for Responsible Sexuality was launched by the Province of Buenos Aires in 1999, in response to concrete demands on the part of poor communities for sexual and reproductive health services, including for young people. This Programme came to an abrupt end with the change of governor in that same year, illustrating the complexity of the policy-making process. These experiences demonstrate the urgency to develop strategies and set up task forces for effective advocacy of health and social programmes, and to make political leaders more aware of the social costs of refusing to support these.

Controversies about cervical cancer screening: A qualitative study of Roma women's (non)participation in cervical cancer screening in Romania.

PubMed

Andreassen, Trude; Weiderpass, Elisabete; Nicula, Florian; Suteu, Ofelia; Itu, Andreea; Bumbu, Minodora; Tincu, Aida; Ursin, Giske; Moen, Kåre

2017-06-01

Romania has Europe's highest incidence and mortality of cervical cancer. While a free national cervical cancer-screening programme has been in operation since 2012, participation in the programme is low, particularly in minority populations. The aim of this study was to explore Roma women's (non)participation in the programme from women's own perspectives and those of healthcare providers and policy makers. We carried out fieldwork for a period of 125 days in 2015/16 involving 144 study participants in Cluj and Bucharest counties. Fieldwork entailed participant observation, qualitative interviewing and focus group discussions. A striking finding was that screening providers and Roma women had highly different takes on the national screening programme. We identified four fundamental questions about which there was considerable disagreement between them: whether a free national screening programme existed in the first place, whether Roma women were meant to be included in the programme if it did, whether Roma women wanted to take part in screening, and to what degree screening participation would really benefit women's health. On the background of insights from actor-network theory, the article discusses to what degree the programme could be said to speak to the interest of its intended Roma public, and considers the controversies in light of the literature on patient centred care and user involvement in health care. The paper contributes to the understanding of the health and health-related circumstances of the largest minority in Europe. It also problematizes the use of the concept of "barriers" in research into participation in cancer screening, and exemplifies how user involvement can potentially help transform and improve screening programmes. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

PubMed Central

De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Flores-Ayala, Rafael; del Socorro Jefferds, Maria Elena

2015-01-01

Objective Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health. PMID:23507463

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening

PubMed Central

2010-01-01

Background Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester). Design A single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care. Methods ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments. Discussion ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians. Trial registration Clinicaltrial.gov (NCT00318032). PMID:20170482

Confronting the stigma of eugenics: genetics, demography and the problems of population.

PubMed

Ramsden, Edmund

2009-12-01

Building upon the work of Thomas Gieryn and Erving Goffman, this paper will explore how the concepts of stigma and boundary work can be usefully applied to history of population science. Having been closely aligned to eugenics in the early 20th century, from the 1930s both demographers and geneticists began to establish a boundary between their own disciplines and eugenic ideology. The eugenics movement responded to this process of stigmatization. Through strategies defined by Goffman as 'disclosure' and 'concealment', stigma was managed, and a limited space for eugenics was retained in science and policy. Yet by the 1960s, a revitalized eugenics movement was bringing leading social and biological scientists together through the study of the genetic demography of characteristics such as intelligence. The success of this programme of 'stigma transformation' resulted from its ability to allow geneticists and demographers to conceive of eugenic improvement in ways that seemed consistent with the ideals of individuality, diversity and liberty. In doing so, it provided them with an alternative, and a challenge, to more radical and controversial programmes to realize an optimal genotype and population. The processes of stigma attribution and management are, however, ongoing, and since the rise of the nature-nurture controversy in the 1970s, the use of eugenics as a 'stigma symbol' has prevailed.

Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia.

PubMed

Liverani, Marco; Nguon, Chea; Sok, Ra; Kim, Daro; Nou, Panharith; Nguon, Sokhan; Yeung, Shunmay

2017-05-08

There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas. Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability. Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment. This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area.

Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis

PubMed Central

2014-01-01

Background Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. Methods We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). Results Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman’s access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. Conclusions Barriers to the uptake of the HPV vaccine have implications for young women’s future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women’s perceptions of, and involvement in, consent and decision-making. PMID:25004868

Politics of Leadership and Implementation of Educational Policies and Programmes of Tertiary Institutions in Cross River State, Nigeria

ERIC Educational Resources Information Center

Ekpiken, W. E.; Ifere, Francis O.

2015-01-01

This paper examines issues of politics of leadership and implementation of Educational policies and programmes of tertiary institutions in Cross River State with a view to determine the problems are situated and suggest the way forward. It examines the concept of politics of education, concept of leadership, meaning of planning and generation of…

The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A comparative analysis

PubMed Central

Nunn, Amy; Dickman, Samuel; Nattrass, Nicoli; Cornwall, Alexandra; Gruskin, Sofia

2013-01-01

Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/ AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines. PMID:23137055

Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

PubMed

Nielsen, Jennifer N; Olney, Deanna K; Ouedraogo, Marcellin; Pedehombga, Abdoulaye; Rouamba, Hippolyte; Yago-Wienne, Fanny

2017-12-26

Evidence is emerging from rigorous evaluations about the effectiveness of nutrition-sensitive agriculture programmes in improving nutritional outcomes. Additional evidence can elucidate how different programme components and pathways contribute and can be optimized for impact. The International Food Policy Research Institute, with Helen Keller International, designed a comprehensive framework to evaluate the delivery, utilization, and impact of Helen Keller International's enhanced homestead food production programme in Burkina Faso. After 18 months of implementation, a process evaluation was conducted to examine programme impact pathways, using key informant and semistructured interviews with implementing agents and beneficiaries, and with residents of control communities. Data were analyzed by International Food Policy Research Institute and reviewed with project managers and partners through multiple workshops to identify opportunities to strengthen implementation. Findings illuminated gaps between intended and actual delivery schemes, including input constraints, knowledge gaps among community agents in agriculture and young child nutrition practices, and lower than expected activity by community volunteers. In response, staff developed measures to overcome water constraints and expand vegetable and poultry production, retrained volunteers in certain techniques of food production and counselling for nutrition behaviour change, added small incentives to motivate volunteers, and shaped both immediate and long-term changes to the programme model. Working closely with International Food Policy Research Institute on the evaluation activities also expanded the repertoire of research methods and skills of Helen Keller International staff. Process evaluation can strengthen programme delivery, utilization, and design. Collaboration between researchers and implementers can improve programme effectiveness, project staff capacity, and advance delivery science. © 2017 John Wiley & Sons Ltd.

Equality and difference: persisting historical themes in health and alcohol policies affecting Indigenous Australians.

PubMed

Brady, Maggie

2007-09-01

Disseminating national health and alcohol policies to Aboriginal and Torres Strait Islander people in Australia has been a challenging task for governments and public servants. This has been for a number of reasons, including the enduring (negative) legacy of past "Aboriginal affairs" policies, the fact that Indigenous health programmes and alcohol programmes have been treated separately since the 1970s, and a more recent context in which the recognition of cultural difference was privileged. Confronted with the politics of difference, health departments were slow to examine avenues through which best practice advice emanating from WHO, and alcohol policies such as harm minimisation and early identification and treatment in primary health care, could be communicated in culturally recognisable ways to independent Indigenous services. In addition, there was hostility towards harm minimisation policies from Indigenous service providers, and Indigenous treatment programmes remained largely committed to abstinence-oriented modalities and the disease model of alcoholism, despite moves away from these approaches in the mainstream. However, genuinely innovative acute interventions and environmental controls over alcohol have been developed by Indigenous community-based organisations, approaches that are reinforced by international policy research evidence.

Social control and coercion in addiction treatment: towards evidence-based policy and practice.

PubMed

Wild, T Cameron

2006-01-01

Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research. Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic. Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views. Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.

Integrating natural and social sciences to inspire public confidence in radioactive waste policy case study - Committee on radioactive waste management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Usher, Sam

2007-07-01

Integrating Natural and Social Sciences to Inspire Public Confidence in Radioactive Waste Policy Case Study: Committee on Radioactive Waste Management Implementing effective long-term radioactive waste management policy is challenging, and both UK and international experience is littered with policy and programme failures. Policy must not only be underpinned by sound science and technical rationale, it must also inspire the confidence of the public and other stakeholders. However, in today's modern society, communities will not simply accept the word of scientists for setting policy based purely on technical grounds. This is particularly so in areas where there are significant social andmore » ethical issues, such as radioactive waste disposal. To develop and implement effective policy, governments, waste owners and implementing bodies must develop processes which effectively integrate both complex technical and scientific issues, with equally challenging social and ethical concerns. These integrating processes must marry often intricate technical issues with broad public and stakeholder engagement programmes, in programmes which can expect the highest levels of public scrutiny, and must invariably be delivered within challenging time and budget constraints. This paper considers a model for how such integrating processes can be delivered. The paper reviews, as a case study, how such challenges were overcome by the Committee on Radioactive Waste Management (CoRWM), which, in July 2006, made recommendations to the UK government for the establishment of a long-term radioactive waste policy. Its recommendations were underpinned by sound science, but also engendered public confidence through undertaking the largest and most significant deliberative public and stakeholder engagement programme on a complex policy issue in the UK. Effective decision-making was enabled through the integration of both proven and bespoke methodologies, including Multi-criteria Decision Analysis and Holistic assessments, coupled with an overarching deliberative approach. How this was managed and delivered to programme demonstrates how important effective integration of different issues, interests and world views can be achieved, and the paper looks forward to how the continued integration of both natural and social sciences is essential if public confidence is to be maintained through implementation stages. This paper will be particularly relevant to governments, waste owners and implementing bodies who are responsible for developing and implementing policy. (author)« less

Projecting the effects of tobacco control policies in the USA through microsimulation: a study protocol.

PubMed

Tam, Jamie; Levy, David T; Jeon, Jihyoun; Clarke, John; Gilkeson, Scott; Hall, Tim; Feuer, Eric J; Holford, Theodore R; Meza, Rafael

2018-03-23

Smoking remains the leading cause of preventable death in the USA but can be reduced through policy interventions. Computational models of smoking can provide estimates of the projected impact of tobacco control policies and can be used to inform public health decision making. We outline a protocol for simulating the effects of tobacco policies on population health outcomes. We extend the Smoking History Generator (SHG), a microsimulation model based on data from the National Health Interview Surveys, to evaluate the effects of tobacco control policies on projections of smoking prevalence and mortality in the USA. The SHG simulates individual life trajectories including smoking initiation, cessation and mortality. We illustrate the application of the SHG policy module for four types of tobacco control policies at the national and state levels: smoke-free air laws, cigarette taxes, increasing tobacco control programme expenditures and raising the minimum age of legal access to tobacco. Smoking initiation and cessation rates are modified by age, birth cohort, gender and years since policy implementation. Initiation and cessation rate modifiers are adjusted for differences across age groups and the level of existing policy coverage. Smoking prevalence, the number of population deaths avoided, and life-years gained are calculated for each policy scenario at the national and state levels. The model only considers direct individual benefits through reduced smoking and does not consider benefits through reduced exposure to secondhand smoke. A web-based interface is being developed to integrate the results of the simulations into a format that allows the user to explore the projected effects of tobacco control policies in the USA. Usability testing is being conducted in which experts provide feedback on the interface. Development of this tool is under way, and a publicly accessible website is available at http://www.tobaccopolicyeffects.org. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Projecting the effects of tobacco control policies in the USA through microsimulation: a study protocol

PubMed Central

Levy, David T; Jeon, Jihyoun; Clarke, John; Gilkeson, Scott; Hall, Tim; Holford, Theodore R; Meza, Rafael

2018-01-01

Introduction Smoking remains the leading cause of preventable death in the USA but can be reduced through policy interventions. Computational models of smoking can provide estimates of the projected impact of tobacco control policies and can be used to inform public health decision making. We outline a protocol for simulating the effects of tobacco policies on population health outcomes. Methods and analysis We extend the Smoking History Generator (SHG), a microsimulation model based on data from the National Health Interview Surveys, to evaluate the effects of tobacco control policies on projections of smoking prevalence and mortality in the USA. The SHG simulates individual life trajectories including smoking initiation, cessation and mortality. We illustrate the application of the SHG policy module for four types of tobacco control policies at the national and state levels: smoke-free air laws, cigarette taxes, increasing tobacco control programme expenditures and raising the minimum age of legal access to tobacco. Smoking initiation and cessation rates are modified by age, birth cohort, gender and years since policy implementation. Initiation and cessation rate modifiers are adjusted for differences across age groups and the level of existing policy coverage. Smoking prevalence, the number of population deaths avoided, and life-years gained are calculated for each policy scenario at the national and state levels. The model only considers direct individual benefits through reduced smoking and does not consider benefits through reduced exposure to secondhand smoke. Ethics and dissemination A web-based interface is being developed to integrate the results of the simulations into a format that allows the user to explore the projected effects of tobacco control policies in the USA. Usability testing is being conducted in which experts provide feedback on the interface. Development of this tool is under way, and a publicly accessible website is available at http://www.tobaccopolicyeffects.org. PMID:29574440

Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV

PubMed Central

2011-01-01

Background In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. Discussion District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. Summary Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not. PMID:21794154

Reduction of multiple pregnancies in the advanced maternal age population after implementation of an elective single embryo transfer policy coupled with enhanced embryo selection: pre- and post-intervention study.

PubMed

Ubaldi, Filippo Maria; Capalbo, Antonio; Colamaria, Silvia; Ferrero, Susanna; Maggiulli, Roberta; Vajta, Gábor; Sapienza, Fabio; Cimadomo, Danilo; Giuliani, Maddalena; Gravotta, Enrica; Vaiarelli, Alberto; Rienzi, Laura

2015-09-01

Is an elective single-embryo transfer (eSET) policy an efficient approach for women aged >35 years when embryo selection is enhanced via blastocyst culture and preimplantation genetic screening (PGS)? Elective SET coupled with enhanced embryo selection using PGS in women older than 35 years reduced the multiple pregnancy rates while maintaining the cumulative success rate of the IVF programme. Multiple pregnancies mean an increased risk of premature birth and perinatal death and occur mainly in older patients when multiple embryos are transferred to increase the chance of pregnancy. A SET policy is usually recommended in cases of good prognosis patients, but no general consensus has been reached for SET application in the advanced maternal age (AMA) population, defined as women older than 35 years. Our objective was to evaluate the results in terms of efficacy, efficiency and safety of an eSET policy coupled with increased application of blastocyst culture and PGS for this population of patients in our IVF programme. In January 2013, a multidisciplinary intervention involving optimization of embryo selection procedure and introduction of an eSET policy in an AMA population of women was implemented. This is a retrospective 4-year (January 2010-December 2013) pre- and post-intervention analysis, including 1161 and 499 patients in the pre- and post-intervention period, respectively. The primary outcome measures were the cumulative delivery rate (DR) per oocyte retrieval cycle and multiple DR. Surplus oocytes and/or embryos were vitrified during the entire study period. In the post-intervention period, all couples with good quality embryos and less than two previous implantation failures were offered eSET. Embryo selection was enhanced by blastocyst culture and PGS (blastocyst stage biopsy and 24-chromosomal screening). Elective SET was also applied in cryopreservation cycles. Patient and cycle characteristics were similar in the pre- and post-intervention groups [mean (SD) female age: 39.6 ± 2.1 and 39.4 ± 2.2 years; range 36-44] as assessed by logistic regression. A total of 1609 versus 574 oocyte retrievals, 937 versus 350 embryo warming and 138 versus 27 oocyte warming cycles were performed in the pre- and post-intervention periods, respectively, resulting in 1854 and 508 embryo transfers, respectively. In the post-intervention period, 289 cycles were blastocyst stage with (n = 182) or without PGS (n = 107). A mean (SD) number of 2.9 ± 1.1 (range 1-4) and 1.4 ± 0.8 (range 1-3) embryos were transferred pre- and post-intervention, respectively (P < 0.01) and similar cumulative clinical pregnancy rates per transfer and per cycle were obtained: 26.8, 30.9% and 29.7, 26.3%, respectively. The total DR per oocyte retrieval cycle (21.0 and 20.4% pre- and post-intervention, respectively) defined as efficacy was not affected by the intervention [odds ratio (OR) = 0.8, 95% confidence interval (CI) = 0.7-1.1; P = 0.23]. However, a significantly increased live birth rate per transferred embryo (defined as efficiency) was observed in the post-intervention group 17.0 versus 10.6% (P < 0.01). Multiple DRs decreased from 21.0 in the preintervention to 6.8% in the post-intervention group (OR = 0.3. 95% CI = 0.1-0.7; P < 0.01). In this study, the suitability of SET was assessed in individual women on the basis of both clinical and embryological prognostic factors and was not standardized. For the described eSET strategy coupled with an enhanced embryo selection policy, an optimized culture system, cryopreservation and aneuploidy screening programme is necessary. Owing to the increased maternal morbidity and perinatal complications related to multiple pregnancies, it is recommended to extend the eSET policy to the AMA population. As shown in this study, enhanced embryo selection procedures might allow a reduction in the number of embryos transferred and the number of transfers to be performed without affecting the total efficacy of the treatment but increasing efficiency and safety. None. None. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Corporate social responsibility: Benefits for youth in hydropower development in Laos

NASA Astrophysics Data System (ADS)

Sparkes, Stephen

2014-04-01

The role of the state as regulator combined with policies on Corporate Social Responsibility (CSR) that go beyond legal requirements to establishing programmes that promote development and good international business practice is an emerging new paradigm. In this paper, the example of a state-owned company, Statkraft A.S. of Norway, and its recent hydropower investment in central Laos illustrates how policy, implementation and follow-up can lead to benefits for local communities in the impacted area of the Theun-Hinboun Expansion Project (THXP). Programmes include both support for and improvement of existing government education programmes, employment opportunities and specific programmes for youth. They have been designed to mitigate possible negative effects of the influx of workers and rapid socio-economic change in the affected area. Young people continue to have a central role in the implementation of these programmes as peer educators under the supervision of project staff and non-governmental organisations (NGOs).

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

PubMed

Kok, Maryse C; Kane, Sumit S; Tulloch, Olivia; Ormel, Hermen; Theobald, Sally; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline E W; de Koning, Korrie A M

2015-03-07

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State

PubMed Central

Salve, Solomon; Sheikh, Kabir; Porter, John DH

2016-01-01

Background: Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. Methods: The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. Results: PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector’s dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as ‘partners with the TB programme.’ Conclusion: Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported. PMID:27801358

Postgraduate Work-Based Learning Programmes in English Higher Education: Exploring Case Studies of Organizational Practice

ERIC Educational Resources Information Center

Smith, Paul; Preece, David

2009-01-01

The first part of the paper outlines and discusses the nature of work-based learning (WBL) and WBL programmes, and the overall direction of government strategy towards WBL programmes in Higher Education (HE) in England, with particular reference to postgraduate programmes, policy documents, and the WBL literature. Drawing upon case study research,…

Equivalency Programmes (EPs) for Promoting Lifelong Learning

ERIC Educational Resources Information Center

Haddad, Caroline, Ed.

2006-01-01

Equivalency programmes (EPs) refers to alternative education programmes that are equivalent to the formal education system in terms of curriculum and certification, policy support mechanisms, mode of delivery, staff training, and other support activities such as monitoring, evaluation and assessment. The development of EPs is potentially an…

Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development.

PubMed

Guhn, Martin; Janus, Magdalena; Enns, Jennifer; Brownell, Marni; Forer, Barry; Duku, Eric; Muhajarine, Nazeem; Raos, Rob

2016-04-29

Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health. Canada-wide EDI records from 2004 to 2014 (representing over 700,000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends. Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Methodological considerations for economic modelling of latent tuberculous infection screening in migrants.

PubMed

Shedrawy, J; Siroka, A; Oxlade, O; Matteelli, A; Lönnroth, K

2017-09-01

Tuberculosis (TB) in migrants from endemic to low-incidence countries results mainly from the reactivation of latent tuberculous infection (LTBI). LTBI screening policies for migrants vary greatly between countries, and the evidence on the cost-effectiveness of the different approaches is weak and heterogeneous. The aim of this review was to assess the methodology used in published economic evaluations of LTBI screening among migrants to identify critical methodological options that must be considered when using modelling to determine value for money from different economic perspectives. Three electronic databases were searched and 10 articles were included. There was considerable variation across this small number of studies with regard to economic perspective, main outcomes, modelling technique, screening options and target populations considered, as well as in parameterisation of the epidemiological situation, test accuracy, efficacy, safety and programme performance. Only one study adopted a societal perspective; others adopted a health care or wider government perspective. Parameters representing the cascade of screening and treating LTBI varied widely, with some studies using highly aspirational scenarios. This review emphasises the need for a more harmonised approach for economic analysis, and better transparency in how policy options and economic perspectives influence methodological choices. Variability is justifiable for some parameters. However, sufficient data are available to standardise others. A societal perspective is ideal, but can be challenging due to limited data. Assumptions about programme performance should be based on empirical data or at least realistic assumptions. Results should be interpreted within specific contexts and policy options, with cautious generalisations.

The cost-effectiveness of varicella and combined varicella and herpes zoster vaccination programmes in the United Kingdom.

PubMed

van Hoek, Albert Jan; Melegaro, Alessia; Gay, Nigel; Bilcke, Joke; Edmunds, W John

2012-02-01

Despite the existence of varicella vaccine, many developed countries have not introduced it into their national schedules, partly because of concerns about whether herpes zoster (HZ, shingles) will increase due to a lack of exogenous boosting. The magnitude of any increase in zoster that might occur is dependent on rates at which adults and children mix - something that has only recently been quantified - and could be reduced by simultaneously vaccinating older individuals against shingles. This study is the first to assess the cost-effectiveness of combined varicella and zoster vaccination options and compare this to alternative programmes. The cost-effectiveness of various options for the use of varicella-zoster virus (VZV) containing vaccines was explored using a transmission dynamic model. Underlying contact rates are estimated from a contemporary survey of social mixing patterns, and uncertainty in these derived from bootstrapping the original sample. The model was calibrated to UK data on varicella and zoster incidence. Other parameters were taken from the literature. UK guidance on perspective and discount rates were followed. The results of the incremental cost-effectiveness analysis suggest that a combined policy is cost-effective. However, the cost-effectiveness of this policy (and indeed the childhood two-dose policy) is influenced by projected benefits that accrue many decades (80-100 years or more) after the start of vaccination. If the programme is evaluated over shorter time frames, then it would be unlikely to be deemed cost-effective, and may result in declines in population health, due to a projected rise in the incidence of HZ. The findings are also sensitive to a number of parameters that are inaccurately quantified, such as the risk of HZ in varicella vaccine responders. Policy makers should be aware of the potential negative benefits in the first 30-50 years after introduction of a childhood varicella vaccine. This can only be partly mitigated by the introduction of a herpes zoster vaccine. They have to decide how they value the potential benefits beyond this time to consider childhood vaccination cost effective. Copyright © 2011 Elsevier Ltd. All rights reserved.

Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies.

PubMed

Ezzati, Majid; Utzinger, Jürg; Cairncross, Sandy; Cohen, Aaron J; Singer, Burton H

2005-01-01

Monitoring and empirical evaluation are essential components of evidence based public health policies and programmes. Consequently, there is a growing interest in monitoring of, and indicators for, major environmental health risks, particularly in the developing world. Current large scale data collection efforts are generally disconnected from micro-scale studies in health sciences, which in turn have insufficiently investigated the behavioural and socioeconomic factors that influence exposure. A basic framework is proposed for development of indicators of exposure to environmental health risks that would facilitate the (a) assessment of the health effects of risk factors, (b) design and evaluation of interventions and programmes to deliver the interventions, and (c) appraisal and quantification of inequalities in health effects of risk factors, and benefits of intervention programmes and policies. Specific emphasis is put on the features of environmental risks that should guide the choice of indicators, in particular the interactions of technology, the environment, and human behaviour in determining exposure. The indicators are divided into four categories: (a) access and infrastructure, (b) technology, (c) agents and vectors, and (d) behaviour. The study used water and sanitation, indoor air pollution from solid fuels, urban ambient air pollution, and malaria as illustrative examples for this framework. Organised and systematic indicator selection and monitoring can provide an evidence base for design and implementation of more effective and equitable technological interventions, delivery programmes, and policies for environmental health risks in resource poor settings.

The inherent tensions arising from attempting to carry out strategic environmental assessments on all policies, plans and programmes

DOE Office of Scientific and Technical Information (OSTI.GOV)

McLauchlan, Anna, E-mail: anna.mclauchlan@strath.ac.uk; Joao, Elsa, E-mail: elsa.joao@strath.ac.uk

2012-09-15

This paper evaluates the tensions that result from routinely applying SEA to all policies, plans and programmes within Scotland. The European Union SEA Directive, effective in many EU member states from 2004, introduced a requirement for environmental assessment of certain plans and programmes. Scotland, a devolved nation within the EU member state of the United Kingdom, aimed to be a 'world leader in SEA' by legislating for SEA to be undertaken of all public sector plans, programmes and strategies, with the word 'strategies' being equated with 'policies'. This paper presents detailed data regarding Scottish SEA activity between 2004 and 2007,more » including responses to consultations on SEA reports. This empirical research found that, reflecting a general difficulty in determining where and when SEA should be applied, engagement with the SEA process was not as widespread as intended (including the pre-screening and screening stages). Eight tensions evident from Scotland's application of SEA are identified, and their broader relevance is examined. - Highlights: Black-Right-Pointing-Pointer We examine detailed data regarding Scottish strategic environmental assessment (SEA) activity. Black-Right-Pointing-Pointer There is a general difficulty in determining where SEA should be applied. Black-Right-Pointing-Pointer Engagement with the SEA process was not as widespread as intended. Black-Right-Pointing-Pointer Eight 'tensions' that question the efficacy of applying SEA to all plans, programmes and policies were identified.« less

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries.

PubMed

Ishizaki, Azumi; Bouscaillou, Julie; Luhmann, Niklas; Liu, Stephanie; Chua, Raissa; Walsh, Nick; Hess, Sarah; Ivanova, Elena; Roberts, Teri; Easterbrook, Philippa

2017-11-01

There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up. Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these. We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers. At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing.

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso.

PubMed

Wuehler, Sara E; Ouedraogo, Albertine Wendpagnagdé

2011-04-01

Progress towards reducing mortality and malnutrition among children < 5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The objectives of the present paper are to compare relevant national policies, training materials, programmes, and monitoring and evaluation activities with internationally accepted IYCN recommendations. These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Burkina Faso were interviewed, and 153 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and treatment of acute malnutrition, prevention of mother-to-child transmission of HIV, food security and hygienic practices. National policy documents addressed nearly all of the key IYCN topics, specifically or generally. Formative research has identified some local barriers and beliefs related to general breastfeeding and complementary feeding practices, and other formative research addressed about half of the IYCN topics included in this review. However, there was little evidence that this formative research was being utilized in developing training materials and designing programme interventions. Nevertheless, the training materials that were reviewed do provide specific guidance for nearly all of the key IYCN topics. Although many of the IYCN programmes are intended for national coverage, we could only confirm with available reports that programme coverage extended to certain regions. Some programme monitoring and evaluation were conducted, but few of these provided information on whether the specific IYCN programme components were implemented as designed. Most surveys that were identified reported on general nutrition status indicators, but did not provide the detail necessary for programme impact evaluations. The policy framework is well established for optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research and adapt training materials and programme protocols to local needs; (ii) improve, carry out, and document monitoring and evaluation that highlight effective and ineffective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

Support for research towards understanding the population health vulnerabilities to vector-borne diseases: increasing resilience under climate change conditions in Africa.

PubMed

Ramirez, Bernadette

2017-12-12

Diseases transmitted to humans by vectors account for 17% of all infectious diseases and remain significant public health problems. Through the years, great strides have been taken towards combatting vector-borne diseases (VBDs), most notably through large scale and coordinated control programmes, which have contributed to the decline of the global mortality attributed to VBDs. However, with environmental changes, including climate change, the impact on VBDs is anticipated to be significant, in terms of VBD-related hazards, vulnerabilities and exposure. While there is growing awareness on the vulnerability of the African continent to VBDs in the context of climate change, there is still a paucity of research being undertaken in this area, and impeding the formulation of evidence-based health policy change. One way in which the gap in knowledge and evidence can be filled is for donor institutions to support research in this area. The collaboration between the WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the International Centre for Research and Development (IDRC) builds on more than 10 years of partnership in research capacity-building in the field of tropical diseases. From this partnership was born yet another research initiative on VBDs and the impact of climate change in the Sahel and sub-Saharan Africa. This paper lists the projects supported under this research initiative and provides a brief on some of the policy and good practice recommendations emerging from the ongoing implementation of the research projects. Data generated from the research initiative are expected to be uptaken by stakeholders (including communities, policy makers, public health practitioners and other relevant partners) to contribute to a better understanding of the impacts of social, environmental and climate change on VBDs(i.e. the nature of the hazard, vulnerabilities, exposure), and improve the ability of African countries to adapt to and reduce the effects of these changes in ways that benefit their most vulnerable populations.

Effects of a dietary self-management programme for community-dwelling older adults: a quasi-experimental design.

PubMed

Chen, Su-Hui; Huang, Yu-Ping; Shao, Jung-Hua

2017-09-01

Nutritional health plays a crucial role in determining successful ageing and differs by different living area. Although nutritional interventions have long been advocated, little research has directly assessed the effectiveness of nutritional interventions on community-dwelling older adults in urban and rural areas and compared intervention effects on these two populations. To examine the effectiveness of a 12-week dietary self-management programme for salt-, fluid-, fat- and cholesterol-intake behaviours of community-dwelling older adults and to compare these effects in rural- and urban-dwelling older adults. For this quasi-experimental two-group study, older adults (≥65 years old) were recruited from two randomly selected public health centres in a rural north-eastern county and a northern city of Taiwan from January through December 2011. Outcomes included nutritional status, nutritional self-efficacy and health locus of control. Data were collected at baseline and 12 weeks later. To compare changes in outcome variables over time between the control (usual care) and intervention (nutritional programme) groups and between the urban- and rural-dwelling participants in the experimental group, we used generalised estimating equation analysis. Of the 129 participants, 120 completed this study (58 in the intervention group and 62 in the control group). After 12 weeks, the intervention group had significantly better nutritional status and higher internal health locus of control than the control group. Moreover, older rural participants who received the intervention tended towards higher nutritional self-efficacy and internal health locus of control than their urban counterparts. Our research findings support the positive effect of our nutritional self-management programme for community-dwelling older adults. The knowledge gained from this study can help stakeholders recognise the need for healthcare policy to establish effective strategies and sustainable intervention programmes for this population, especially those living in rural areas. © 2016 Nordic College of Caring Science.

Backing the winners and the research infrastructure.

PubMed

Leliveld, H

1985-04-26

The industrial policy of the Dutch government is a priority area policy, that backs the winners of today and, even more, the potential winners of tomorrow. Important elements of this policy are the selection of high-chance activities, setting up new and informal relationships, promoting co-operation and supporting industrial research and development. To this end the government has set up Innovative Research Programmes and an Innovation Stimulation Scheme. Co-operation of universities and industry is essential for these programmes to succeed. Also international co-operation is a precondition to a firm position of European industry. The establishment of the Center for Bio-Pharmaceutical Sciences is entirely in line with the objectives of this policy.

The post-2015 development agenda for diabetes in sub-Saharan Africa: challenges and future directions

PubMed Central

Renzaho, Andre M. N.

2015-01-01

Background Diabetes is one of the non-communicable diseases (NCDs) which is rising significantly across sub-Saharan African (SSA) countries and posing a threat to the social, economic, and cultural fabric of the SSA population. The inclusion of NCDs into the post-2015 development agenda along with the global monitoring framework provides an opportunity to monitor progress of development programmes in developing countries. This paper examines challenges associated with dealing with diabetes within the development agenda in SSA and explores some policy options. Design This conceptual review draws from a range of works published in Medline and the grey literature to advance the understanding of the post-2015 development agenda and how it relates to NCDs. The paper begins with the burden of diabetes in sub-Sahara Africa and then moves on to examine challenges associated with diabetes prevention, treatment, and management in Africa. It finishes by exploring policy implications. Results With regards to development programmes on NCDs in the SSA sub-continent, several challenges exist: 1) poor documentation of risk factors, 2) demographic transitions (rapid urbanisation and ageing), 3) the complementary role of traditional healers, 4) tuberculosis and the treatment of the acquired immunodeficiency syndrome as risk factors for diabetes, 5) diabetes in complex emergencies, 6) diabetes as an international development priority and not a policy agenda for many SSA countries, and 7) poorly regulated food and beverage industry. Conclusion For the post-2015 development agenda for NCDs to have an impact, sufficient investments will be needed to address legislative, technical, human, and fiscal resource constraints through advocacy, accountability, political leadership, and effective public–private partnership. Striking the right balance between competing demands and priorities, policies, and implementation strategies hold the key to an effective response to diabetes in SSA countries. PMID:25994288

The post-2015 development agenda for diabetes in sub-Saharan Africa: challenges and future directions.

PubMed

Renzaho, Andre M N

2015-01-01

Diabetes is one of the non-communicable diseases (NCDs) which is rising significantly across sub-Saharan African (SSA) countries and posing a threat to the social, economic, and cultural fabric of the SSA population. The inclusion of NCDs into the post-2015 development agenda along with the global monitoring framework provides an opportunity to monitor progress of development programmes in developing countries. This paper examines challenges associated with dealing with diabetes within the development agenda in SSA and explores some policy options. This conceptual review draws from a range of works published in Medline and the grey literature to advance the understanding of the post-2015 development agenda and how it relates to NCDs. The paper begins with the burden of diabetes in sub-Sahara Africa and then moves on to examine challenges associated with diabetes prevention, treatment, and management in Africa. It finishes by exploring policy implications. With regards to development programmes on NCDs in the SSA sub-continent, several challenges exist: 1) poor documentation of risk factors, 2) demographic transitions (rapid urbanisation and ageing), 3) the complementary role of traditional healers, 4) tuberculosis and the treatment of the acquired immunodeficiency syndrome as risk factors for diabetes, 5) diabetes in complex emergencies, 6) diabetes as an international development priority and not a policy agenda for many SSA countries, and 7) poorly regulated food and beverage industry. For the post-2015 development agenda for NCDs to have an impact, sufficient investments will be needed to address legislative, technical, human, and fiscal resource constraints through advocacy, accountability, political leadership, and effective public-private partnership. Striking the right balance between competing demands and priorities, policies, and implementation strategies hold the key to an effective response to diabetes in SSA countries.

‘Why do an MPH?’ Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

PubMed Central

Zweigenthal, Virginia E.M.; Marquez, Emma; London, Leslie

2016-01-01

Background Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications. Objectives This study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training. Design A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town. Results Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training. Conclusions The MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment. PMID:27741958

Manpower Policy and Programmes in Canada. Reviews of Manpower and Social Policies No. 4.

ERIC Educational Resources Information Center

Organisation for Economic Cooperation and Development, Paris (France).

This report describes the Canadian labor force and economic climate, and the employment and manpower policies which comprise Canada's active manpower policy. Expanded programs for vocational and technical training are recommended, especially for unemployed youth. (BH)

Rational care or rationing care? The case of cervical screening across the United Kingdom.

PubMed

Flynn, Hannah; Lewis, Philippa

2013-10-01

In 2003, The National Health Service Cervical Screening Programme (NHSCSP) in England modified its recommendation by increasing the age at which to begin screening from 20 to 25. This was on the grounds that normal changes in the cervix before the age of 25 are often identified during screening as being abnormal, resulting in many young women receiving unnecessary treatment at both a significant psychological cost to the patient and a financial cost to the service. In 2011, the cervical screening programme in Northern Ireland was also amended followed closely by Scotland in late 2012. Some 10 years later, Wales finally altered cervical screening policy in January 2013 and now invite women for an initial screen at the age of 25, in line with the rest of the United Kingdom (UK). The withdrawal of cervical screening from 20 to 24 years in England was the first occasion globally, where a population cancer screening programme was withdrawn. Although the changes in England were perceived by some as "rational care" - as they encourage utilisation of beneficial services while discouraging use of those that may lead to more harms than benefits, many people also believe them to be "rationing care". In fact, even now, a decade on from the policy alterations in England, people are still vociferously exhibiting their discontent at the decision; exacerbated by national media headlines such as: "Denying young women smear tests is a disgrace". Yet with recent, rather alarming analysis of trends in England suggesting a rise in the incidence of cervical cancer in young women, it seems of great public health interest to consider whether such a rise is attributable to reduced cervical screening activity and reflect on whether the decision to alter cervical screening policy for those under the age of 25 was, in fact, a rational and correct decision. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Increasing reach of quitline services in a US state with comprehensive tobacco treatment.

PubMed

Woods, Susan Swartz; Haskins, Amy E

2007-12-01

The population reach of tobacco quitlines is an important measure of treatment seeking and penetration of services. Maine offers an opportunity to examine temporal changes in quitline reach and referral sources in the context of a comprehensive tobacco treatment programme. The impact of a $1.00 cigarette tax increase is also examined. This is a descriptive analysis of Maine Tobacco Helpline call volume September 2001 to December 2006. Annual reach was estimated using a cross sectional state surveillance survey. Weekly call volume was examined during 2005, a year of marked changes in tobacco taxes and quitline resources. Referral patterns were analysed yearly. Maine's Tobacco Helpline observed more than a threefold increase in population reach during a four year interval, from 1.9% to over 6% per year. Calls increased substantially in 2005, concurrent with added hours of operation and a rise in the cigarette tax. Over time, callers increasingly reported hearing about the quitline from health professionals, from 10% in 2001 to 38% in 2006. Tobacco treatment programmes offering free nicotine therapy and professional medical education can drive quitline utilisation over time. Call volume can also be affected by quitline operational and policy changes that promote the reduction of tobacco use.

Tools to improve planning, implementation, monitoring, and evaluation of complementary feeding programmes.

PubMed

Untoro, Juliawati; Childs, Rachel; Bose, Indira; Winichagoon, Pattanee; Rudert, Christiane; Hall, Andrew; de Pee, Saskia

2017-10-01

Adequate nutrient intake is a prerequisite for achieving good nutrition status. Suboptimal complementary feeding practices are a main risk factor for stunting. The need for systematic and user-friendly tools to guide the planning, implementation, monitoring, and evaluation of dietary interventions for children aged 6-23 months has been recognized. This paper describes five tools, namely, ProPAN, Optifood, Cost of the Diet, Fill the Nutrient Gap, and Monitoring Results for Equity System that can be used in different combinations to improve situation analysis, planning, implementation, monitoring, or evaluation approaches for complementary feeding in a particular context. ProPAN helps with development of strategies and activities designed to change the behaviours of the target population. Optifood provides guidance for developing food-based recommendations. The Cost of the Diet can provide insight on economic barriers to accessing a nutritious and balanced diet. The Fill the Nutrient Gap facilitates formulation of context-specific policies and programmatic approaches to improve nutrient intake, through a multistakeholder process that uses insights from linear programming and secondary data. The Monitoring Results for Equity System helps with analysis of gaps, constraints, and determinants of complementary feeding interventions and adoption of recommended practices especially in the most vulnerable and deprived populations. These tools, and support for their use, are readily available and can be used either alone and/or complementarily throughout the programme cycle to improve infant and young child-feeding programmes at subnational and national levels. © 2017 John Wiley & Sons Ltd.

Evaluating the delivery, impact, costs and benefits of an active lives programme for older people living in the community.

PubMed

Gandy, Rob; Bell, Amelia; McClelland, Bob; Roe, Brenda

2017-03-01

Aim Age UK Lancashire received Big Lottery funding to deliver an active lives programme from January 2012 to December 2014 to the population of West Lancashire aged over 50 years. The overall aims of the associated evaluation were to measure older people's experiences of participating in the programme, identify the impacts on their health and well-being and their suggestions for services development, and establish the costs and benefits of the programme. The World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers. A mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish people's experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation. Findings The active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available.

Information visualisation for science and policy: engaging users and avoiding bias.

PubMed

McInerny, Greg J; Chen, Min; Freeman, Robin; Gavaghan, David; Meyer, Miriah; Rowland, Francis; Spiegelhalter, David J; Stefaner, Moritz; Tessarolo, Geizi; Hortal, Joaquin

2014-03-01

Visualisations and graphics are fundamental to studying complex subject matter. However, beyond acknowledging this value, scientists and science-policy programmes rarely consider how visualisations can enable discovery, create engaging and robust reporting, or support online resources. Producing accessible and unbiased visualisations from complicated, uncertain data requires expertise and knowledge from science, policy, computing, and design. However, visualisation is rarely found in our scientific training, organisations, or collaborations. As new policy programmes develop [e.g., the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES)], we need information visualisation to permeate increasingly both the work of scientists and science policy. The alternative is increased potential for missed discoveries, miscommunications, and, at worst, creating a bias towards the research that is easiest to display. Copyright © 2014 Elsevier Ltd. All rights reserved.

Oral health information systems--towards measuring progress in oral health promotion and disease prevention.

PubMed Central

Petersen, Poul Erik; Bourgeois, Denis; Bratthall, Douglas; Ogawa, Hiroshi

2005-01-01

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide. PMID:16211160

Development Programme, 1983-1989.

PubMed

1987-01-01

This document reprints provisions of Chile's Development Program for 1983-89. The population and family objectives of the Program include: strengthening the right of every couple to decide freely the number of their children by providing everyone with access to information and adequate health care services, as well as seeking a balanced population growth and appropriate geographic distribution for this increased population. Specific policies include protecting human life from the moment of conception; offering family planning methods that may include sterilization but not abortion; recognizing the equality of women and their right to participate in economic and social development without arbitrary discrimination while validating their role as mothers; social protection of minors; provision of special services to underprivileged children; inclusion of a "family education" course in schools; promotion of programs of family development for the general public; and encouragement of women's participation as volunteers in accomplishing tasks of social action.

Six challenges in modelling for public health policy.

PubMed

Metcalf, C J E; Edmunds, W J; Lessler, J

2015-03-01

The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014). Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

The Scottish Government's Rural and Environmental Science and Analytical Services Strategic Research Progamme

NASA Astrophysics Data System (ADS)

Dawson, Lorna; Bestwick, Charles

2013-04-01

The Strategic Research Programme focuses on the delivery of outputs and outcomes within the major policy agenda areas of climate change, land use and food security, and to impact on the 'Wealthier', 'Healthier' and 'Greener' strategic objectives of the Scottish Government. The research is delivered through two programmes: 'Environmental Change' and 'Food, Land and People'; the core strength of which is the collaboration between the Scottish Government's Main Research Providers-The James Hutton Institute, the Moredun Research Institute, Rowett Institute of Nutrition and Health University of Aberdeen, Scotland's Rural College, Biomathematics and Statistics Scotland and The Royal Botanic Gardens Edinburgh. The research actively seeks to inform and be informed by stakeholders from policy, farming, land use, water and energy supply, food production and manufacturing, non-governmental organisations, voluntary organisations, community groups and general public. This presentation will provide an overview of the programme's interdisciplinary research, through examples from across the programme's themes. Examples will exemplify impact within the Strategic Programme's priorities of supporting policy and practice, contributing to economic growth and innovation, enhancing collaborative and multidisciplinary research, growing scientific resilience and delivering scientific excellence. http://www.scotland.gov.uk/Topics/Research/About/EBAR/StrategicResearch/future-research-strategy/Themes/ http://www.knowledgescotland.org/news.php?article_id=295

Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada

PubMed Central

Nickel, Nathan Christopher; Warda, Lynne; Kummer, Leslie; Chateau, Joanne; Heaman, Maureen; Green, Chris; Katz, Alan; Paul, Julia; Perchuk, Carolyn; Girard, Darlene; Larocque, Lorraine; Enns, Jennifer Emily; Shaw, Souradet

2017-01-01

Introduction Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother–infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme. Methods and analysis Routinely collected administrative health data on mothers’ infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are. Ethics and dissemination Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals. PMID:29061626

Of taps and toilets: quasi-experimental protocol for evaluating community-demand-driven projects.

PubMed

Pattanayak, Subhrendu K; Poulos, Christine; Yang, Jui-Chen; Patil, Sumeet R; Wendland, Kelly J

2009-09-01

Sustainable and equitable access to safe water and adequate sanitation are widely acknowledged as vital, yet neglected, development goals. Water supply and sanitation (WSS) policies are justified because of the usual efficiency criteria, but also major equity concerns. Yet, to date there are few scientific impact evaluations showing that WSS policies are effective in delivering social welfare outcomes. This lack of an evaluation culture is partly because WSS policies are characterized by diverse mechanisms, broad goals and the increasing importance of decentralized delivery, and partly because programme administrators are unaware of appropriate methods. We describe a protocol for a quasi-experimental evaluation of a community-demand-driven programme for water and sanitation in rural India, which addresses several evaluation challenges. After briefly reviewing policy and implementation issues in the sector, we describe key features of our protocol, including control group identification, pre-post measurement, programme theory, sample sufficiency and robust indicators. At its core, our protocol proposes to combine propensity score matching and difference-in-difference estimation. We conclude by briefly summarizing how quasi-experimental impact evaluations can address key issues in WSS policy design and when such evaluations are needed.

Australian Universities' Strategic Goals of Student Exchange and Participation Rates in Outbound Exchange Programmes

ERIC Educational Resources Information Center

Daly, Amanda; Barker, Michelle

2010-01-01

International student exchange programmes are acknowledged as one aspect of a broader suite of internationalisation strategies aimed at enhancing students' intercultural understanding and competence. The decision to participate in an exchange programme is dependent on both individual and contextual factors such as student exchange policies and…

Erasmus Mundus SEN: The Inclusive Scholarship Programme?

ERIC Educational Resources Information Center

Grinbergs, Christopher J.; Jones, Hilary

2013-01-01

The Erasmus Mundus MA/Mgr in Special Education Needs (EM SEN) was created as a Masters Course funded by the European Commission's Erasmus Mundus Programme (EMP) to challenge and educate students in inclusive policy and practice in education. Yet, it is debatable the extent to which this programme embodies the values of an inclusive approach,…

The introduction of mentorship to Project 2000 in Wales.

PubMed

Neary, M; Phillips, R; Davies, B

1996-03-13

This study focused upon the introduction of mentors in the Common Foundation Programme (CFP) of Project 2000 (UKCC 1986) in Wales. It was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division. The study was policy oriented and its purpose was to inform future policy decision making through an analysis of the implementation of current policies for pre-registration education. The full title of our research project, 'The practitioner teacher: a study in the introduction of mentors in the pre-registration nurse education programme', implied that a clinically-based nurse practitioner with a designated teaching remit, fulfills a particular role (that of mentor) in the pre-registration nurse education programme. It was the nature, scope and impact of this mentor role during the initial implementation period of the CFP of Project 2000 in Wales to which this study addressed itself.

How do researchers influence decision-makers? Case studies of Mexican policies.

PubMed

Trostle, J; Bronfman, M; Langer, A

1999-06-01

Though the problems translating or applying research in policy-making are legion, solutions are rare. As developing countries increase their capacities to develop effective local solutions to their health problems, they confront the research/policy dilemma. Yet few descriptive studies of research-policy links can be found from developing countries, and the relevance of European and North American models and data is questionable. We report the results of a descriptive study from Mexico of the relationship between health research and policy in four vertical programmes (AIDS, cholera, family planning, immunization). We interviewed 67 researchers and policy-makers from different institutions and levels of responsibility. We analyzed interviewee responses looking for factors that promoted or impeded exchanges between researchers and policy-makers. These were, in turn, divided into emphases on content, actors, process, and context. Many of the promoting factors resembled findings from studies in industrialized countries. Some important differences across the four programmes, which also distinguish them from industrialized country programmes, included extent of reliance on formal communication channels, role of the mass media in building social consensus or creating discord, levels of social consensus, role of foreign donors, and extent of support for biomedical versus social research. We recommend various ways to increase the impact of research on health policy-making in Mexico. Some of the largest challenges include the fact that researchers are but one of many interest groups, and research but one input among many equally legitimate elements to be considered by policy-makers. Another important challenge in Mexico is the relatively small role played by the public in policy-making. Further democratic changes in Mexico may be the most important incentive to increase the use of research in policy-making.

Statistics on Diphtheria

MedlinePlus

... and diseases Global Vaccine Action Plan WHO policy recommendations SAGE Immunization schedules Position papers Advisory committees National programmes and systems Policy and strategies Service delivery Linking with other ...

Quality of nursing doctoral education in Korea: towards policy development.

PubMed

Ja Kim, Mi; Gi Park, Chang; Kim, Minju; Lee, Hyeonkyeong; Ahn, Yang-Heui; Kim, Euisook; Yun, Soon-Nyoung; Lee, Kwang-Ja

2012-07-01

This article is a report on an international study of the quality of nursing doctoral education; herein, we report findings for Korea. Specific aims were to: examine the validity and reliability of the quality of nursing doctoral education questionnaire; and identify contributing factors and domain(s) for improvement. The quality of nursing doctoral education has been a worldwide concern with the recent rapid increase in number of nursing doctoral programmes around the world, and comprehensive evaluation is needed for policy recommendations. A cross-sectional descriptive study, conducted from October 2006 to January 2007, used an online questionnaire evaluating four domains: programme, faculty, resources and evaluation. Seven deans, 48 faculty, 52 graduates and 87 students from 14 nursing schools participated. Content and construct validity, and construct reliability of the questionnaire were established. Overall, participants reported that the perceived quality of private universities/schools was significantly higher than that of public/national universities. A higher ratio of doctoral to non-doctoral students was significantly associated with higher quality. The domains of programme, faculty and resources were highly correlated. The programme was the most important domain; availability of sufficient materials and information for students most needed improvement. Overall, faculty perceived the quality of the programme, faculty and resources as more positively than did the graduates and students. This study provides useful policy guidance for nurse educators worldwide for improving doctoral programmes and faculty's role in educating students. Further study is recommended that examines contributing factors to quality doctoral education. © 2011 Blackwell Publishing Ltd.

Challenges in the management of support and care programmes for child-headed households in South Africa.

PubMed

Human, Sarie P; van Rensburg, Gisela H

2011-10-01

The present study reports on data collected in a larger study on 'A situational analysis of child-headed households in South Africa'. The purpose of this study was to explore the management and control of available and required services, resources and safety nets for children in child-headed households. The significance of having a better understanding of the challenges, limitations but importance for government structures to manage and control programmes will enhance the implementation and maintenance of focused and sustainable support structures and programmes which will effectively address the needs of child-headed households. An exploratory and descriptive, quantitative survey was conducted to provide information on government structures at a national level and the nine provinces in South Africa. The population consisted of the Departments of Social Development, Education, Health and Agriculture, at both national and provincial levels. The main findings included a lack of clarity regarding the concept and definition of a child-headed household, lack of empirical data, a diversity of needs and challenges in terms of location and geographical distribution of available infrastructure and support systems; programmes that are not inclusive and integrated; and contradictions in the stipulations and implementation of existing policies and capacity and human resources shortages. It was concluded that the magnitude, uniqueness and complexity of the phenomenon necessitate effective and sound scientific management principles. This is achieved by providing legal clarity of the concept; developing relevant policies and ensuring effective implementation thereof; rigorous monitoring and evaluation based on comprehensive empirical data; and protecting the rights and safety of these children and ensuring an enabling environment for all stakeholders to address needs and challenges. The role of the nurse manager is to ensure a holistic approach to children living in child-headed households by acting as a facilitator, advocate, leader, coordinator and consultant. © 2011 Blackwell Publishing Ltd.

Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues

PubMed Central

Hall, A.E.; Chowdhury, S.; Hallowell, N.; Pashayan, N.; Dent, T.; Pharoah, P.; Burton, H.

2014-01-01

Background The identification of common genetic variants associated with common cancers including breast, prostate and ovarian cancers would allow population stratification by genotype to effectively target screening and treatment. As scientific, clinical and economic evidence mounts there will be increasing pressure for risk-stratified screening programmes to be implemented. Methods This paper reviews some of the main ethical, legal and social issues (ELSI) raised by the introduction of genotyping into risk-stratified screening programmes, in terms of Beauchamp and Childress's four principles of biomedical ethics—respect for autonomy, non-maleficence, beneficence and justice. Two alternative approaches to data collection, storage, communication and consent are used to exemplify the ELSI issues that are likely to be raised. Results Ultimately, the provision of risk-stratified screening using genotyping raises fundamental questions about respective roles of individuals, healthcare providers and the state in organizing or mandating such programmes, and the principles, which underpin their provision, particularly the requirement for distributive justice. Conclusions The scope and breadth of these issues suggest that ELSI relating to risk-stratified screening will become increasingly important for policy-makers, healthcare professionals and a wide diversity of stakeholders. PMID:23986542

"If donors woke up tomorrow and said we can't fund you, what would we do?" A health system dynamics analysis of implementation of PMTCT option B+ in Uganda.

PubMed

Doherty, Tanya; Besada, Donnela; Goga, Ameena; Daviaud, Emmanuelle; Rohde, Sarah; Raphaely, Nika

2017-07-26

In October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes and adoptions of new PMTCT policies have not been accompanied by health systems research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to 'Universal Test and Treat', a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems. This qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. A total of 82 individual interviews and 16 focus group discussions were completed. We conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes. Of the ten elements in the health system dynamics framework, context and resources (finances, infrastructure & supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability. The health system dynamics framework offers a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation.

PubMed

Guthrie, Susan; Bienkowska-Gibbs, Teresa; Manville, Catriona; Pollitt, Alexandra; Kirtley, Anne; Wooding, Steven

2015-08-01

The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.

Situational analysis of infant and young child nutrition policies and programmatic activities in Mali.

PubMed

Wuehler, Sara E; Coulibaly, Mouctar

2011-04-01

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with a situational analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse and interpret available information on infant and young child feeding, and the nutrition situation of children <2 years of age in Mali, as one of the six targeted countries. Between June and September 2008, key informants responsible for conducting IYCN-related activities in Mali were interviewed, and 117 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and management of acute malnutrition, prevention of mother-to-child transmission of HIV, food security, and hygienic practices. Most of the key IYCN topics were addressed in national policies, training materials, and programme documents. Information on the national coverage and impact of these programmes is generally not available. Exclusive breastfeeding (<6 months) has increased in Mali, but no studies identified the contributors to this increase. Despite improvements in breastfeeding practices, optimal infant, and young child feeding is still practiced among too few young children in Mali. Several research articles were identified, but few of these were linked to programme development. Some programme monitoring and evaluation reports were available, but few of these were rigorous enough to identify whether IYCN-specific programme components were implemented as designed or were achieving desired outcomes. Therefore, we could not confirm which programmes contributed to reported improvements. Monitoring of programmes managing malnutrition identified gaps in human and institutional capacities to fully carry out intended interventions and the government has recognized the overall lack of adequate numbers of health care providers to carry out necessary programmes in Mali, of which nutrition programmes are a part. The policy and programme framework is well established for support of optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research to adapt training materials and programme protocols to programmatic needs; (ii) implement rigorous monitoring and evaluation that identify effective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy.

PubMed

Holl, Katsiaryna; Sauboin, Christophe; Amodio, Emanuele; Bonanni, Paolo; Gabutti, Giovanni

2016-10-21

Varicella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget. Scenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years. Both one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10-14 years old reduced varicella cases by 27-43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27-31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2-5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination. Vaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme.

Convocation address.

PubMed

Swaminathan, M S

1998-07-01

This address delivered to the 40th convocation of the International Institute for Population Sciences in India in 1998 opens by noting that a shortage of jobs for youth is India's most urgent problem but that the problems that attend the increasing numbers of elderly also require serious attention. The address then notes that the Earth's population is growing at an unsustainable rate while economic inequities among countries are increasing, so that, while intellectual property is becoming the most important asset in developed countries, nutritional anemia among pregnant women causes their offspring to be unable to achieve their full intellectual potential from birth. Next, the address uses a discussion of the 18th-century work on population of the Marquis de Condorcet and of Thomas Malthus to lead into a consideration of estimated increased needs of countries like India and China to import food grains in the near future. Next, the progress of demographic transition in Indian states is covered and applied to Mahbub ul Haq's measure of human deprivation developed for and applied to the region of the South Asian Association for Regional Cooperation (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives). The address continues by reiterating some of the major recommendations forwarded by a government of India committee charged in 1995 with drafting a national population policy. Finally, the address suggests specific actions that could be important components of the Hunger-Free India Programme and concludes that all success rests on the successful implementation of appropriate population policies.

Public mental health: the time is ripe for translation of evidence into practice.

PubMed

Wahlbeck, Kristian

2015-02-01

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice. © 2015 World Psychiatric Association.

Public mental health: the time is ripe for translation of evidence into practice

PubMed Central

Wahlbeck, Kristian

2015-01-01

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice. PMID:25655149

Farmer attitudes to vaccination and culling of badgers in controlling bovine tuberculosis.

PubMed

Warren, M; Lobley, M; Winter, M

2013-07-13

Controversy persists in England, Wales and Northern Ireland concerning methods of controlling the transmission of bovine tuberculosis (bTB) between badgers and cattle. The National Trust, a major land-owning heritage organisation, in 2011, began a programme of vaccinating badgers against bTB on its Killerton Estate in Devon. Most of the estate is farmed by 18 tenant farmers, who thus have a strong interest in the Trust's approach, particularly as all have felt the effects of the disease. This article reports on a study of the attitudes to vaccination of badgers and to the alternative of a culling programme, using face-to-face interviews with 14 of the tenants. The results indicated first that the views of the respondents were more nuanced than the contemporary public debate about badger control would suggest. Secondly, the attitude of the interviewees to vaccination of badgers against bTB was generally one of resigned acceptance. Thirdly, most respondents would prefer a combination of an effective vaccination programme with an effective culling programme, the latter reducing population of density sufficiently (and preferably targeting the badgers most likely to be diseased) for vaccination to have a reasonable chance of success. While based on a small sample, these results will contribute to the vigorous debate concerning contrasting policy approaches to bTB control in England, Wales and Northern Ireland.

Enhancing the Industrial PhD Programme as a Policy Tool for University-Industry Cooperation

ERIC Educational Resources Information Center

Roolaht, Tõnu

2015-01-01

The changing role of universities in society includes the increasing expectation that academic institutions should engage in collaboration with companies. Industrial PhD programmes are educational tools for building bridges between the academic sector and industry. In these programmes, the PhD student studies and carries out research while being…

Impact and Cost-Effectiveness Analysis of the National School-Based Sexuality Education Programme in Estonia

ERIC Educational Resources Information Center

Kivela, Jari; Haldre, Kai; Part, Kai; Ketting, Evert; Baltussen, Rob

2014-01-01

Policy-makers making decisions on the implementation of school-based sexuality education (SE) programmes face two important questions: (1) what are the costs of implementing and scaling up SE programmes, and (2) what are the impacts? This paper responds to these questions by retrospectively assessing costs, impact and cost-effectiveness of the…

Withdrawing low risk women from cervical screening programmes: mathematical modelling study.

PubMed

Sherlaw-Johnson, C; Gallivan, S; Jenkins, D

1999-02-06

To evaluate the impact of policies for removing women before the recommended age of 64 from screening programmes for cervical cancer in the United Kingdom. A mathematical model of the clinical course of precancerous lesions which accounts for the influence of infection with the human papillomavirus, the effects of screening on the progression of disease, and the accuracy of the testing procedures. Two policies are compared: one in which women are withdrawn from the programme if their current smear is negative and they have a recent history of regular, negative results and one in which women are withdrawn if their current smear test is negative and a simultaneous test is negative for exposure to high risk types of human papillomavirus. United Kingdom cervical screening programme. The incidence of invasive cervical cancer and the use of resources. Early withdrawal of selected women from the programme is predicted to give rise to resource savings of up to 25% for smear tests and 18% for colposcopies when withdrawal occurs from age 50, the youngest age considered in the study. An increase in the incidence of invasive cervical cancer, by up to 2 cases/100 000 women each year is predicted. Testing for human papillomavirus infection to determine which women should be withdrawn from the programme makes little difference to outcome. This model systematically analyses the consequences of screening options using available data and the clinical course of precancerous lesions. If further audit studies confirm the model's forecasts, a policy of early withdrawal might be considered. This would be likely to release substantial resources which could be channelled into other aspects of health care or may be more effectively used within the cervical screening programme to counteract the possible increase in cancer incidence that early withdrawal might bring.

Operational challenges to continuous LLIN distribution: a qualitative rapid assessment in four countries.

PubMed

Theiss-Nyland, Katherine; Ejersa, Waqo; Karema, Corine; Koné, Diakalia; Koenker, Hannah; Cyaka, Yves; Lynch, Matthew; Webster, Jayne; Lines, Jo

2016-03-01

The World Health Organization recommends that long-lasting insecticidal nets (LLINs) for malaria prevention should be distributed continuously through antenatal care (ANC) and the expanded programme on immunization (EPI) in addition to mass campaigns. Despite these recommendations, the continuous distribution (CD) of LLIN distribution through ANC and EPI is not policy in many countries, and where there is a policy, implementation is incomplete. This study aims to identify the operational strengths and weaknesses of LLINs CD in four country programmes in sub-Saharan Africa. A qualitative rapid assessment process was conducted using semi-structured individual and group interviews at the national, sub-national, and facility level in four countries. Seventy participants were included (23 in Kenya, 13 in Malawi, 18 in Mali and 16 in Rwanda), drawn from malaria programmes, ANC and EPI programmes, government logistics units, and partner organizations. Interviews were structured to identify themes within a health systems approach. Policy and guideline documents and data collection tools were reviewed as a means of triangulation. Data analysis focused on pre-determined and emergent themes. The four countries used a wide variety of management systems for the supply of LLINs to routine services. Issues related to quantification, supply logistics and data collection all contributed to stock-outs at facility level. None of the four countries had guidelines for responding to stock-outs or system enabling local staff to request additional supplies of LLINs. In all four countries, data collection of LLIN distribution was incomplete or absent at facility level, and such data were not used for planning. Training of staff at the facility level was implemented less frequently than national and sub-national staff would have preferred. Logistics systems, independent of other commodities, and in-country partner support strengthened the continuous distribution of LLINs. In these countries, stock-outs were the most important single obstacle to the smooth operations of continuous LLIN distribution. Stock-outs can be avoided if facilities have the capacity to place orders for LLIN resupply as needed. Revised data collection and management systems for LLIN distribution have the potential to increase coverage of the target populations by improving LLIN stock-out response, and strengthening monitoring and evaluation of distribution.

The Brazilian school feeding programme: an example of an integrated programme in support of food and nutrition security.

PubMed

Sidaner, Emilie; Balaban, Daniel; Burlandy, Luciene

2013-06-01

The present paper analyses the advances and challenges of the school feeding programme in Brazil (PNAE), as part of the Brazilian experience building up an integrated food and nutrition security national system. It explores the role of policy and regulatory frameworks in constructing quality service delivery and intersectoral integration. Review of PNAE and federal government technical documents and studies, legislation, minutes of meetings and official documents of the National Council of Food and Nutrition Security from 2003 to 2011. Food insecurity has decreased significantly in Brazil in the last decade, indicating that appropriate choices were made in terms of public policies and institutional arrangements, which other countries can learn from. Brazil food and nutrition security system; school feeding; school food. Brazil's integrated food and nutrition security policy approach promoted intersectorality in the food system, articulating actions to guarantee access to healthy food and to strengthen family farming. The quality of school meals has progressively improved; in particular, the availability of fruits and vegetables increased. However, national standards regarding menu composition have not yet been met. Regulations were an important factor, along with the policy approach linking food production, nutrition, health and education. Challenges are related to conflict of interests and to farmers' insufficient capacity to meet supply requirements and comply with technical procedures. Local food production, school meals and nutrition education can be linked through integrated programmes and policies, improving access to healthier foods. Government leadership, strong legislation, civil society participation and intersectoral decision making are determinant.

$17 billion needed for population programme to year 2000: Dr. Nafis Sadik launches State of World Population Report.

PubMed

1995-01-01

Dr. Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA), in her address on July 11 to the Foreign Press Association in London on the occasion of the release of the "1995 State of the World Population Report," stated that governments needed to invest in people, and that the estimated amount needed to reduce population numbers in developing countries was $17 billion for the year 2000. Two-thirds of the cost would be supplied by the developing countries. She said that coordinating population policies globally through such documents as the Programme of Action from the Cairo Conference would aid in slowing population growth. World population, currently 5.7 billion, is projected to reach 7.1-7.83 billion in 2015 and 7.9-11.9 billion in 2050. She also noted that certain conditions faced by women bear upon unsustainable population growth. The cycle of poverty continues in developing countries because very young mothers, who face higher risks in pregnancy and childbirth than those who delay childbearing until after the age of 20, are less likely to continue their education, more likely to have lower-paying jobs, and have a higher rate of separation and divorce. The isolation of women from widespread political participation and the marginalization of women's concerns from mainstream topics has resulted in ineffective family planning programs, including prevention of illness or impairment related to pregnancy or childbirth. Women, in most societies, cannot fully participate in economic and public life, have limited access to positions of influence and power, have narrower occupational choices and lower earnings than men, and must struggle to reconcile activities outside the home with their traditional roles. Sustainable development can only be achieved when social development expands opportunities for individuals (men and women), and their families, empowering them in the attainment of their social, economic, political, and cultural aspirations.

Effectiveness of return-to-work interventions for disabled people: a systematic review of government initiatives focused on changing the behaviour of employers.

PubMed

Clayton, Stephen; Barr, Ben; Nylen, Lotta; Burström, Bo; Thielen, Karsten; Diderichsen, Finn; Dahl, Espen; Whitehead, Margaret

2012-06-01

OECD countries over the past two decades have implemented a range of labour market integration initiatives to improve the employment chances of disabled and chronically ill individuals. This article presents a systematic review and evidence synthesis on effectiveness of government interventions to influence employers' employment practices concerning disabled and chronically ill individuals in five OECD countries. A separate paper reports on interventions to influence the behaviour of employees. Electronic and grey literature searches to identify all empirical studies reporting employment effects and/or process evaluations of government policies aimed at changing the behaviour of employers conducted between 1990 and 2008 from Canada, Denmark, Norway, Sweden and the UK. Few studies provided robust evaluations of the programmes or their differential effects and selection of participants into programmes may distort the findings of even controlled studies. A population-level effect of legislation to combat discrimination by employers could not be detected. Workplace adjustments had positive impacts on employment, but low uptake. Financial incentives such as wage subsidies can work if they are sufficiently generous. Involving employers in return-to-work planning can reduce subsequent sick leave and be appreciated by employees, but this policy has not been taken up with the level of intensity that is likely to make a difference. Some interventions favour the more advantaged disabled people and those closer to the labour market. Future evaluations need to pay more attention to differential impact of interventions, degree of take-up, non-stigmatizing implementation and wider policy context in each country.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

Review: Towards the agroecological management of ruminants, pigs and poultry through the development of sustainable breeding programmes. II. Breeding strategies.

PubMed

Phocas, F; Belloc, C; Bidanel, J; Delaby, L; Dourmad, J Y; Dumont, B; Ezanno, P; Fortun-Lamothe, L; Foucras, G; Frappat, B; González-García, E; Hazard, D; Larzul, C; Lubac, S; Mignon-Grasteau, S; Moreno, C R; Tixier-Boichard, M; Brochard, M

2016-11-01

Agroecology uses ecological processes and local resources rather than chemical inputs to develop productive and resilient livestock and crop production systems. In this context, breeding innovations are necessary to obtain animals that are both productive and adapted to a broad range of local contexts and diversity of systems. Breeding strategies to promote agroecological systems are similar for different animal species. However, current practices differ regarding the breeding of ruminants, pigs and poultry. Ruminant breeding is still an open system where farmers continue to choose their own breeds and strategies. Conversely, pig and poultry breeding is more or less the exclusive domain of international breeding companies which supply farmers with hybrid animals. Innovations in breeding strategies must therefore be adapted to the different species. In developed countries, reorienting current breeding programmes seems to be more effective than developing programmes dedicated to agroecological systems that will struggle to be really effective because of the small size of the populations currently concerned by such systems. Particular attention needs to be paid to determining the respective usefulness of cross-breeding v. straight breeding strategies of well-adapted local breeds. While cross-breeding may offer some immediate benefits in terms of improving certain traits that enable the animals to adapt well to local environmental conditions, it may be difficult to sustain these benefits in the longer term and could also induce an important loss of genetic diversity if the initial pure-bred populations are no longer produced. As well as supporting the value of within-breed diversity, we must preserve between-breed diversity in order to maintain numerous options for adaptation to a variety of production environments and contexts. This may involve specific public policies to maintain and characterize local breeds (in terms of both phenotypes and genotypes), which could be used more effectively if they benefited from the scientific and technical resources currently available for more common breeds. Last but not least, public policies need to enable improved information concerning the genetic resources and breeding tools available for the agroecological management of livestock production systems, and facilitate its assimilation by farmers and farm technicians.

Start-stop funding, its causes and consequences: a case study of the delivery exemptions policy in Ghana.

PubMed

Witter, Sophie; Adjei, Sam

2007-01-01

This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding--such as party politics and intersectoral haggling over resources--are unavoidable, but others, such as communication and management failures can and should be addressed. Copyright (c) 2007 John Wiley & Sons, Ltd.

An economic model to evaluate the mitigation programme for bovine viral diarrhoea in Switzerland.

PubMed

Häsler, B; Howe, K S; Presi, P; Stärk, K D C

2012-09-15

Economic analyses are indispensable as sources of information to help policy makers make decisions about mitigation resource use. The aim of this study was to conduct an economic evaluation of the Swiss national mitigation programme for bovine viral diarrhoea virus (BVDV), which was implemented in 2008 and concludes in 2017. The eradication phase of the mitigation programme comprised testing and slaughtering of all persistently infected (PI) animals found. First, the whole population was antigen tested and all PI cattle removed. Since October 2008, all newborn calves have been subject to antigen testing to identify and slaughter PI calves. All mothers of PI calves were retested and slaughtered if the test was positive. Antigen testing in calves and elimination of virus-carriers was envisaged to be conducted until the end of 2011. Subsequently, a surveillance programme will document disease freedom or detect disease if it recurs. Four alternative surveillance strategies based on antibody testing in blood from newborn calves and/or milk from primiparous cows were proposed by Federal Veterinary Office servants in charge of the BVDV mitigation programme. A simple economic spreadsheet model was developed to estimate and compare the costs and benefits of the BVDV mitigation programme. In an independent project, the impact of the mitigation programme on the disease dynamics in the population was simulated using a stochastic compartment model. Mitigation costs accrued from materials, labour, and processes such as handling and testing samples, and recording results. Benefits were disease costs avoided by having the mitigation programme in place compared to a baseline of endemic disease equilibrium. Cumulative eradication costs and benefits were estimated to determine the break-even point for the eradication component of the programme. The margin over eradication cost therefore equalled the maximum expenditure potentially available for surveillance without the net benefit from the mitigation programme overall becoming zero. Costs of the four surveillance strategies and the net benefit of the mitigation programme were estimated. Simulations were run for the years 2008-2017 with 20,000 iterations in @Risk for Excel. The mean baseline disease costs were estimated to be 16.04 m CHF (1 Swiss Franc, CHF=0.73 € at the time of analysis) (90% central range, CR: 14.71-17.39 m CHF) in 2008 and 14.89 m CHF (90% CR: 13.72-16.08 m CHF) in 2009. The break-even point was estimated to be reached in 2012 and the margin over eradication cost 63.15m CHF (90% CR: 53.72-72.82 m CHF). The discounted cost for each surveillance strategy was found to be smaller than the margin, so the mitigation programme overall is expected to have a positive net economic benefit irrespective of the strategy adopted. For economic efficiency, the least cost surveillance alternative must be selected. Copyright © 2012 Elsevier B.V. All rights reserved.

Stakeholder analysis of the Programme for Improving Mental health carE (PRIME): baseline findings.

PubMed

Makan, Amit; Fekadu, Abebaw; Murhar, Vaibhav; Luitel, Nagendra; Kathree, Tasneem; Ssebunya, Joshua; Lund, Crick

2015-01-01

The knowledge generated from evidence-based interventions in mental health systems research is seldom translated into policy and practice in low and middle-income countries (LMIC). Stakeholder analysis is a potentially useful tool in health policy and systems research to improve understanding of policy stakeholders and increase the likelihood of knowledge translation into policy and practice. The aim of this study was to conduct stakeholder analyses in the five countries participating in the Programme for Improving Mental health carE (PRIME); evaluate a template used for cross-country comparison of stakeholder analyses; and assess the utility of stakeholder analysis for future use in mental health policy and systems research in LMIC. Using an adapted stakeholder analysis instrument, PRIME country teams in Ethiopia, India, Nepal, South Africa and Uganda identified and characterised stakeholders in relation to the proposed action: scaling-up mental health services. Qualitative content analysis was conducted for stakeholder groups across countries, and a force field analysis was applied to the data. Stakeholder analysis of PRIME has identified policy makers (WHO, Ministries of Health, non-health sector Ministries and Parliament), donors (DFID UK, DFID country offices and other donor agencies), mental health specialists, the media (national and district) and universities as the most powerful, and most supportive actors for scaling up mental health care in the respective PRIME countries. Force field analysis provided a means of evaluating cross-country stakeholder power and positions, particularly for prioritising potential stakeholder engagement in the programme. Stakeholder analysis has been helpful as a research uptake management tool to identify targeted and acceptable strategies for stimulating the demand for research amongst knowledge users, including policymakers and practitioners. Implementing these strategies amongst stakeholders at a country level will hopefully reduce the knowledge gap between research and policy, and improve health system outcomes for the programme.

Social, economic, political and health system and program determinants of child mortality reduction in China between 1990 and 2006: A systematic analysis.

PubMed

Feng, Xing Lin; Theodoratou, Evropi; Liu, Li; Chan, Kit Yee; Hipgrave, David; Scherpbier, Robert; Brixi, Hana; Guo, Sufang; Chunmei, Wen; Chopra, Mickey; Black, Robert E; Campbell, Harry; Rudan, Igor; Guo, Yan

2012-06-01

Between 1990 and 2006, China reduced its under-five mortality rate (U5MR) from 64.6 to 20.6 per 1000 live births and achieved the fourth United Nation's Millennium Development Goal nine years ahead of target. This study explores the contribution of social, economic and political determinants, health system and policy determinants, and health programmes and interventions to this success. For each of the years between 1990 and 2006, we obtained an estimate of U5MR for 30 Chinese provinces from the annual China Health Statistics Yearbook. For each year, we also obtained data describing the status of 8 social, 10 economic, 2 political, 9 health system and policy, and six health programmes and intervention indicators for each province. These government data are not of the same quality as some other health information sources in modern China, such as articles with primary research data available in Chinese National Knowledge Infrastructure (CNKI) and Wan Fang databases, or Chinese Maternal and Child Mortality Surveillance system. Still, the comparison of relative changes in underlying indicators with the undisputed strong general trend of childhood mortality reduction over 17 years should still capture the main effects at the macro-level. We used multivariate random effect regression models to determine the effect of 35 indicators individually and 5 constructs defined by factor analysis (reflecting effects of social, economic, political, health systems and policy, and health programmes) on the reduction of U5MR in China. In the univariate regression applied with a one-year time lag, social determinants of health construct showed the strongest crude association with U5MR reduction (R(2) = 0.74), followed by the constructs for health programmes and interventions (R(2) = 0.65), economic (R(2) = 0.47), political (R(2) = 0.28) and health system and policy determinants (R(2) = 0.26), respectively. Similarly, when multivariate regression was applied with a one-year time lag, the social determinants construct showed the strongest effect (beta = 11.79, P < 0.0001), followed by the construct for political factors (beta = 4.24, P < 0.0001) and health programmes and interventions (beta = -3.45, P < 0.0001). The 5 studied constructs accounted for about 80% of variability in U5MR reduction across provinces over the 17-year period. Vertical intervention programs, health systems strengthening or economic growth alone may all fail to achieve the desired reduction in child mortality when improvement of the key social determinants of health is lagging behind. To accelerate progress toward MDG4, low- and middle-income countries should undertake appropriate efforts to promote maternal education, reduce fertility rates, integrate minority populations and improve access to clean water and safe sanitation. A cross-sectoral approach seems most likely to have the greatest impact on U5MR.

Associations between national viral hepatitis policies/programmes and country-level socioeconomic factors: a sub-analysis of data from the 2013 WHO viral hepatitis policy report.

PubMed

Lazarus, Jeffrey V; Sperle, Ida; Safreed-Harmon, Kelly; Gore, Charles; Cebolla, Beatriz; Spina, Alexander

2017-07-26

As more countries worldwide develop national viral hepatitis strategies, it is important to ask whether context-specific factors affect their decision-making. This study aimed to determine whether country-level socioeconomic factors are associated with viral hepatitis programmes and policy responses across WHO Member States (MS). WHO MS focal points completed a questionnaire on national viral hepatitis policies. This secondary analysis of data reported in the 2013 Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States used logistic regression to examine associations between four survey questions and four socioeconomic factors: country income level, Human Development Index (HDI), health expenditure and physician density. This analysis included 119 MS. MS were more likely to have routine viral hepatitis surveillance and to have a national strategy and/or policy/guidelines for preventing infection in healthcare settings if they were in the higher binary categories for income level, HDI, health expenditure and physician density. In multivariable analyses, the only significant finding was a positive association between having routine surveillance and being in the higher binary HDI category (adjusted odds ratio 26; 95% confidence interval 2.0-340). Countries with differing socioeconomic status indicators did not appear to differ greatly regarding the existence of key national policies and programmes. A more nuanced understanding of the multifaceted interactions of socioeconomic factors, health policy, service delivery and health outcomes is needed to support country-level efforts to eliminate viral hepatitis.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

PubMed

Bosch-Capblanch, Xavier; Marceau, Claudine

2014-12-01

To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

PubMed Central

Bosch–Capblanch, Xavier; Marceau, Claudine

2014-01-01

Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations. PMID:25520793

Systematic Review: the use of vouchers for reproductive health services in developing countries: systematic review.

PubMed

Bellows, Nicole M; Bellows, Ben W; Warren, Charlotte

2011-01-01

To identify where vouchers have been used for reproductive health (RH) services, to what extent RH voucher programmes have been evaluated, and whether the programmes have been effective. A systematic search of the peer review and grey literature was conducted to identify RH voucher programmes and evaluation findings. Experts were consulted to verify RH voucher programme information and identify further programmes and studies not found in the literature search. Studies were examined for outcomes regarding targeting, costs, knowledge, utilization, quality, and population health impact. Included studies used cross-sectional, before-and-after and quasi-experimental designs. Thirteen RH voucher programmes fitting established criteria were identified. RH voucher programmes were located in Bangladesh, Cambodia, China, Kenya (2), Korea, India, Indonesia, Nicaragua (3), Taiwan, and Uganda. Among RH voucher programmes, 7 were quantitatively evaluated in 15 studies. All evaluations reported some positive findings, indicating that RH voucher programmes increased utilization of RH services, improved quality of care, and improved population health outcomes. The potential for RH voucher programmes appears positive; however, more research is needed to examine programme effectiveness using strong study designs. In particular, it is important to see stronger evidence on cost-effectiveness and population health impacts, where the findings can best direct governments and external funders. © 2010 Blackwell Publishing Ltd.

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study.

PubMed

Struelens, M J; Wagner, D; Bruce, J; MacKenzie, F M; Cookson, B D; Voss, A; van den Broek, P J; Gould, I M

2006-08-01

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Use of human rights to meet the unmet need for family planning.

PubMed

Cottingham, Jane; Germain, Adrienne; Hunt, Paul

2012-07-14

In this report, we describe how human rights can help to shape laws, policies, programmes, and projects in relation to contraceptive information and services. Applying a human rights perspective and recognising the International Conference on Population and Development and Millennium Development Goal commitments to universal access to reproductive health including family planning, we support measurement of unmet need for family planning that encompasses more groups than has been the case until recently. We outline how human rights can be used to identify, reduce, and eliminate barriers to accessing contraception; the ways in which human rights can enhance laws and policies; and governments' legal obligations in relation to contraceptive information and services. We underline the crucial importance of accountability of states and identify some of the priorities for making family planning available that are mandated by human rights. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Development of a French-language online health policy course: an international collaboration].

PubMed

Hébert, Réjean; Coppieters, Yves; Pradier, Christian; Williams-Jones, Bryn; Brahimi, Cora; Farley, Céline

2017-01-01

To present the process and challenges of developing an online competency-based course on public health policy using a collaborative international approach. Five public health experts, supported by an expert in educational technology, adopted a rigorous approach to the development of the course: a needs analysis, identification of objectives and competencies, development of a pedagogical scenario for each module and target, choice of teaching methods and learning activities, material to be identified or developed, and the responsibilities and tasks involved. The 2-credit (90-hour) graduate course consists of six modules including an integration module. The modules start with a variety of case studies: tobacco law (neutral packaging), supervised injection sites, housing, integrated services for the frail elderly, a prevention programme for mothers from disadvantaged backgrounds, and the obligatory use of bicycle helmets. In modules 1, 3, 4 and 5, students learn about different stages of the public policy development process: emergence, formulation and adoption, implementation and evaluation. Module 2 focuses on the importance of values and ideologies in public policy. The integration module allows the students to apply the knowledge learned and addresses the role of experts in public policy and ethical considerations. The course has been integrated into the graduate programmes of the participating universities and allows students to follow, at a distance, an innovative training programme.

The Evolution of Policy Enactment on Gender-Based Violence in Schools

ERIC Educational Resources Information Center

Parkes, Jenny

2016-01-01

This article examines how policies and strategies to address school-related gender-based violence have evolved since 2000, when gender-based violence within education was largely invisible. Through an exploration of policy enactment in three countries--Liberia, South Africa, and Brazil--it traces remarkable progress in policy, programmes, and…

Is There a Relation between School Smoking Policies and Youth Cigarette Smoking Knowledge and Behaviors?

ERIC Educational Resources Information Center

Darling, Helen; Reeder, Anthony I.; Williams, Sheila; McGee, Rob

2006-01-01

To comply with workplace legislation, New Zealand schools are required to have policies regarding tobacco smoking. Many schools also have policies to prevent tobacco use by students, including education programmes, cessation support and punishment for students found smoking. This paper investigated the associations between school policies and the…

Cairo conference affirms CEDPA priorities.

PubMed

1995-01-01

The International Conference on Population and Development (ICPD) that was held in Cairo during September adopted a 20-year Programme of Action endorsing the empowerment of women as the foundation of sustainable development. 178 countries and more than a 1000 nongovernmental organizations (NGOs), including the Centre for Development and Population Activities (CEDPA), from 100 countries attended the conference and the parallel NGO forum. The final document sets out specific steps for achievement of universal access to a full range of voluntary, quality family planning and reproductive health services for women and men; provision of services for the special needs of adolescents; closure of the gender gap in education; and empowerment of women via education, health care, and economic options. The CEDPA network of alumnae from 30 countries had worked over the 3 years prior to the conference for the inclusion of women's priorities in policies and to achieve consensus among the government and NGO caucuses. 14 alumnae, including Peggy Curlin (CEDPA President and US delegate), were appointed to their countries' delegations and directly influenced the Programme of Action. The NGO Forum provided a place to exchange experiences and expertise; CEDPA mounted an exhibit, "Empowering Women." The network's theme was "Access, Choice, and Participation." With support from the United Nations Population Fund, CEDPA developed a manual, "After Cairo: A Handbook on Advocacy for Women Leaders," which has been distributed at training sessions and workshops and was translated into French (with support from the US Agency for International Development in Mali) for distribution at the Dakar conference in November in preparation for the World Conference on Women. CEDPA and The Global Committee for Cairo honored the secretary-general of the conference, Dr. Nafis Sadik, for her leadership of the ICPD and UNFPA, and Aziza Hussein, co-chair of the NGO steering committee, at a luncheon; Dr. Sadik received the Global Committee for Cairo Award. Planning the implementation of the Programme of Action has already begun among CEDPA partners and network NGOs. Advocacy networks have already been organized in India and Kenya, with support from CEDPA, to monitor and promote the Programme of Action.

Impact of mammography screening programmes on breast cancer mortality in Switzerland, a country with different regional screening policies.

PubMed

Herrmann, Christian; Vounatsou, Penelope; Thürlimann, Beat; Probst-Hensch, Nicole; Rothermundt, Christian; Ess, Silvia

2018-03-14

In the past decades, mortality due to breast cancer has declined considerably in Switzerland and other developed countries. The reasons for this decline remain controversial as several factors occurred almost simultaneously, including important advances in treatment approaches, breast cancer awareness and the introduction of mammography screening programmes in many European countries. In Switzerland, mammography screening programmes (MSPs) have existed in some regions for over 20 years but do not yet exist in others. This offers the possibility to analyse its effects with modern spatiotemporal methodology. We aimed to assess the spatiotemporal patterns and the effect of MSPs on breast cancer mortality. Switzerland. The study covers breast cancer deaths of the female population of Switzerland during the period 1969-2012. We retrieved data from the Swiss Federal Statistical Office aggregated on a small-area level. We fitted Bayesian hierarchical spatiotemporal models on death rates indirectly standardised by national references. We used linguistic region, degree of urbanisation, duration of population-based screening programmes and socioeconomic index as covariates. In Switzerland, breast cancer mortality in women slightly increased until 1989-1992 and declined strongly thereafter. Until 2009-2012, the standardised mortality ratio declined to 57% (95% CI 54% to 60%) of the 1969-1972 value. None of the other coefficients of the spatial regressions had a significant effect on breast cancer mortality. In 2009-2012, no region had significantly elevated or reduced breast cancer mortality at 95% credible interval level compared with the national mean. There has been a strong reduction of breast cancer mortality from the 1990s onwards. No important spatial disparities were observed. The factors studied (urbanisation, language, duration of population-based MSP and socioeconomic characteristics) did not seem to have an influence on them. Low participation rates and opportunistic screening use may have contributed to the low impact of MSPs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance

PubMed Central

2013-01-01

South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment. Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders’ views and evidences of all sorts. We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa. PMID:24107435

Newborn survival in Pakistan: a decade of change and future implications.

PubMed

Khan, Amanullah; Kinney, Mary V; Hazir, Tabish; Hafeez, Assad; Wall, Stephen N; Ali, Nabeela; Lawn, Joy E; Badar, Asma; Khan, Ali Asghar; Uzma, Qudsia; Bhutta, Zulfiqar A

2012-07-01

Pakistan has the world's third highest national number of newborn deaths (194 000 in 2010). Major national challenges over the past decade have affected health and development including several large humanitarian disasters, destabilizing political insurgency, high levels of poverty and an often hard-to-reach predominately rural population with diverse practices. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Neonatal mortality declined by only 0.9% per annum between 2000 and 2010; less than the global average (2.1%) and less than national maternal and child mortality declines. Coverage of newborn care interventions increased marginally, with wide socio-economic variations. There was little focus on newborn health until 2000 when considerable policy change occurred, including integration of newborn care into existing community-based maternal and child packages delivered by the Lady Health Worker Programme and national behaviour change communications strategies and programmes. The National Maternal, Newborn and Child Health Programme catalyzed newborn services at both facility and community levels. Civil society and academics have linked with government and several research studies have been highly influential. Since 2005, donor funding mentioning the term 'newborn' has increased more for Pakistan than for other countries. The country faces ongoing challenges in reducing neonatal mortality, and in much of Pakistan, societal norms discourage care-seeking and many women are unable to access care for themselves or their children. The policy advances and existing delivery platforms offer the potential to substantially accelerate progress in reducing neonatal deaths. The recent decision to dismantle the national Ministry of Health and devolve responsibility for health sector management to the provincial level presents both challenges and opportunities for newborn health.

Policy over Procedure: A Look at the School Completion Programme in Ireland. Is This State Led Educational Intervention for Disadvantaged Children Merely Philanthropic and Can Current Global and National Neo Liberal Policy Trends in Education Be Overcome?

ERIC Educational Resources Information Center

McKenna, Declan

2015-01-01

"An overview of contemporary curriculum discourse shows a worrying drift to the technical; in current curriculum debates, technique is winning out over substance, procedure over principles" (Looney 2001, p.149). As a project worker in the School Completion Programme in Ireland I ask what and who education is for and look at to whom and…

'And they kill me, only because I am a girl'...a review of sex-selective abortions in South Asia.

PubMed

Abrejo, Farina Gul; Shaikh, Babar Tasneem; Rizvi, Narjis

2009-02-01

The low social status of women and the preference for sons determine a high rate of sex-selective abortion or, more specifically, female feticide, in South Asian countries. Although each of them, irrespective of its abortion policy, strictly condemns sex-selective abortion, data suggest high rates of such procedures in India, Nepal, China and Bangladesh. This paper reviews the current situation of sex-selective abortion, the laws related to it and the factors contributing to its occurrence within these countries. Based on this review, it is concluded that sex selective abortion is a public health issue as it contributes to high maternal mortality. Abortion policies of South Asian countries vary greatly and this influences the frequency of reporting of cases. Several socio-economic factors are responsible for sex-selective abortion including gender discriminating cultural practices, irrational national population policies and unethical use of technology. Wide social change promoting women's status in society should be instituted whereby women are offered more opportunities for better health, education and economic participation through gender sensitive policies and programmes. A self-regulation of the practices in the medical profession and among communities must be achieved through behavioural change campaigns.

Implementation of the International Classification of Functioning, Disability and Health in national legislation and policy in Japan.

PubMed

Okawa, Yayoi; Ueda, Satoshi

2008-03-01

The purpose of this paper is to present the results of a survey on the implementation of the International Classification of Functioning, Disability and Health (ICF) in legislation and policy in the fields of health, welfare and disability in Japan. In pursuance of this aim, we scrutinized the relevant laws, regulations and policy statements issued in Japan in recent years. As a result, it was found that the ICF had been introduced into the following regional and national policy statements and legislations: (i) the 'Biwako Millenium Framework for Action Towards an Inclusive, Barrier-free and Rights-based Society for Persons with Disabilities in Asia and the Pacific'; (ii) the 'Basic Programme for Persons with Disabilities'; (iii) national medical and personal care insurance systems; (iv) the report of the commission on 'the Care of the Elderly People'; (v) the report of the commission on 'the Rehabilitation of the Elderly People'; (vi) disability prevention in the elderly population; (vii) support for an independent life for people with mental disability living in the community; (viii) disability prevention after natural disasters; and (ix) the survey and care of patients with asthma due to air pollution.

Lessons Learned from PISA: A Systematic Review of Peer-Reviewed Articles on the Programme for International Student Assessment

ERIC Educational Resources Information Center

Hopfenbeck, Therese N.; Lenkeit, Jenny; El Masri, Yasmine; Cantrell, Kate; Ryan, Jeanne; Baird, Jo-Anne

2018-01-01

International large-scale assessments are on the rise, with the Programme for International Student Assessment (PISA) seen by many as having strategic prominence in education policy debates. The present article reviews PISA-related English-language peer-reviewed articles from the programme's first cycle in 2000 to its most current in 2015. Five…

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

PubMed

Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

2014-05-01

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention.

PubMed

Erausquin, Jennifer Toller; Biradavolu, Monica; Reed, Elizabeth; Burroway, Rebekah; Blankenship, Kim M

2012-10-01

Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention. The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time. The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009-2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009-2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time. Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs.

Problems in implementing a good food and nutrition policy in Britain.

PubMed Central

James, W. P.

1980-01-01

There is no co-ordinated food and nutrition policy in Britain, primarily because it is still not recognized that diet has an important role to play in the development of many diseases of affluence. The demand for absolute proof of the dietary component of disease on a population level ignores both the innate biological susceptibility in only a portion of the population to a particular nutrient as well as the increasing evidence from studies on non-human primates that diet plays a key role in several conditions including heart disease. Government remains unsure of how to implement its own current recommendations and the traditional paternalistic and conservative approach delays action. Vested interests, seeking only short-term gains, are not confined to industrial concerns. Marketing Boards are allowed almost unfettered freedom to promote nutritionally undesirable eating habits. Health education in schools remains inadequate with most of the involved teachers still promoting incorrect concepts. The medical profession is still unwilling to take a physician maintaining treatment programmes for marginal effects on a public health problem. General practitioners are better able to start practising preventive medicine but they need to be helped by community physicians who should begin on their main task of implementing policies for preventing disease rather than limiting themselves to their current preoccupation with systems analyses and operational research. PMID:7465465

Rights questioned. Limitations of poverty-reduction policies in Argentina.

PubMed

Faur, Eleonor; Campos, Luis; Pautassi, Laura; Zimerman, Silvina

2009-01-01

This article analyses, from a human rights' approach, a group of social programmes implemented in Argentina from the year 2002, at the time of the biggest socioeconomic crisis that the country has suffered in the last decades. The main characteristics of the programmes are reviewed, and their anti-poverty strategy, along with design and implementation, are evaluated in relation to human rights. An assessment is also made of the existence of mechanisms for citizens to present claims. Finally, a set of recommendations are made to facilitate the adaptation of the programmes analysed to the duties the State of Argentina has as result of its adherence to international laws on human rights. The analytical methodology proposed by this article could be applied to other policy areas.

Bangladesh policy on prevention and control of non-communicable diseases: a policy analysis.

PubMed

Biswas, Tuhin; Pervin, Sonia; Tanim, Md Imtiaz Alam; Niessen, Louis; Islam, Anwar

2017-06-19

This paper is aimed at critically assessing the extent to which Non-Communicable Disease NCD-related policies introduced in Bangladesh align with the World Health Organization's (WHO) 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. The authors reviewed all relevant policy documents introduced by the Government of Bangladesh since its independence in 1971. The literature review targeted scientific and grey literature documents involving internet-based search, and expert consultation and snowballing to identify relevant policy documents. Information was extracted from the documents using a specific matrix, mapping each document against the six objectives of the WHO 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. A total of 51 documents were identified. Seven (14%) were research and/or surveys, nine were on established policies (17%), while seventeen (33%) were on action programmes. Five (10%) were related to guidelines and thirteen (25%) were strategic planning documents from government and non-government agencies/institutes. The study covered documents produced by the Government of Bangladesh as well as those by quasi-government and non-government organizations irrespective of the extent to which the intended policies were implemented. The policy analysis findings suggest that although the government has initiated many NCD-related policies or programs, they lacked proper planning, implementation and monitoring. Consequently, Bangladesh over the years had little success in effectively addressing the growing burden of non-communicable diseases. It is imperative that future research critically assess the effectiveness of national NCD policies by monitoring their implementation and level of population coverage.

Is current eye-care-policy focus almost exclusively on cataract adequate to deal with blindness in India?

PubMed

Dandona, L; Dandona, R; Naduvilath, T J; McCarty, C A; Nanda, A; Srinivas, M; Mandal, P; Rao, G N

1998-05-02

India's National Programme for Control of Blindness focuses almost exclusively on cataract, based on a national survey done in the 1980s which reported that cataract caused 80% of the blindness in India. No current population-based data on the causes of blindness in India are available. We assessed the rate and causes of blindness in an urban population in southern India. We selected 2954 participants by stratified, random, cluster, systematic sampling from Hyderabad city. Eligible participants were interviewed and given a detailed ocular assessment, including visual acuity, refraction, slitlamp biomicroscopy, applanation intraocular pressure, gonioscopy, dilatation, grading of cataract, stereoscopic fundus assessment, and automated-threshold visual fields. 2522 participants, including 1399 aged 30 years or more, were assessed. 49 participants (all aged > or =30 years) were blind (presenting distance visual acuity <6/60 or central visual field <200 in the better eye). The rate of blindness among those aged 30 years or more, adjusted for age and sex, was 3.08% ([95% CI 1.95-4.21]). Causes included cataract (29.7%), retinal disease (17.1%), corneal disease (15.4%), refractive error (12.5%), glaucoma (12.1%), and optic atrophy (11.0%). 15.7% of the blindness caused by visual-field constriction would have been missed without visual-field examination. Also without visual-field and detailed dilated-fundus assessments, blindness attributed to cataract would have been overestimated by up to 75.8%. If the use of cataract surgery in this urban population was half that found in this study, which simulates the situation in rural India, cataract would have caused 51.8% (39.4-64.2) of blindness, significantly less than the 80% accepted by current policy. Much of the blindness in this Indian population was due to non-cataract causes. The previous national survey did not include detailed dilated-fundus assessment and visual-field examination which could have led to overestimation of cataract as a cause of blindness in India. Policy-makers in India should encourage well-designed population-based epidemiological studies from which to develop a comprehensive long-term policy on blindness in addition to dealing with cataract.

Integrating mental health into post-conflict rehabilitation: the case of Sierra Leonean and Liberian 'child soldiers'.

PubMed

Medeiros, Emilie

2007-05-01

This report discusses the relationship between mental health care and post-conflict rehabilitation in Sierra Leone and Liberia. Data were collected during the author's involvement in mental health programmes for extremely distressed so called 'child soldiers' in both countries, as well as involvement in co-ordinating and supporting professionals in charge of the war-affected population. Analysis suggested that mental health was neglected. However consideration of mental health is crucial to rehabilitation efforts because it facilitates understanding and appropriate responses to the difficulties encountered by both professionals and demobilized youth, and needs to be incorporated into designing policy, training and interventions.

Mass media barriers to social marketing interventions: the example of sun protection in the UK.

PubMed

Kemp, Gillian Ann; Eagle, Lynne; Verne, Julia

2011-03-01

The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.

Epidemiological analysis of factors influencing rate of progress in Echinococcus granulosus control in New Zealand.

PubMed Central

Burridge, M. J.; Schwabe, C. W.

1977-01-01

The factors influencing the rate of progress in Echinococcus granulosus control in New Zealand were analysed by hydatid control area using stepwise multiple regression techniques. The results indicated that the rate of progress was related positively to initial E. granulosus prevalence in dogs and the efficiency with which local authorities implemented national control policy, and negatively to the Maori proportion in the local population and the number of dogs per owner. Problems in analysis of the New Zealand data are discussed and improved methods of monitoring progress in hydatid disease control programmes are described. Images Fig. 1 PMID:265340

Screening for Infectious Diseases among Newly Arrived Migrants: Experiences and Practices in Non-EU Countries of the Mediterranean Basin and Black Sea.

PubMed

Napoli, Christian; Dente, Maria Grazia; Kärki, Tommi; Riccardo, Flavia; Rossi, Pasqualino; Declich, Silvia

2015-12-08

Changing migration dynamics in the Mediterranean Sea and differences in infectious diseases (ID) burden between the countries of origin have raised questions whether public health actions are needed to avoid the transmission of ID. Screening newly arrived migrants for ID is one health monitoring option, offering opportunities for prevention, early detection and treatment. The authors conducted a survey among country experts in non-European Union countries of the Mediterranean and Black Sea, in order to explore current ID screening practices and policies for newly arrived migrants. The association between the existence of guidelines and the proportion of refugees in the population was also estimated. Eighteen country experts responded (90%) out of the 20 invited. Eleven countries (61%) implemented screening programmes and six (38%) had national guidelines. Screening was performed most often for tuberculosis at the holding level. A higher proportion of refugees in the population was associated with the existence of guidelines for screening (p = 0.05). Fourteen experts (88%) considered screening among migrants useful. The results show that screening for ID in newly arrived migrants is relevant for non-EU countries of the Mediterranean and Black Sea. Common guidelines could be promoted focusing on both individual and public health benefits of screening programmes.

HIV/AIDS in Asia.

PubMed

Ruxrungtham, Kiat; Brown, Tim; Phanuphak, Praphan

HIV (ie, HIV-1) epidemics in Asia show great diversity, both in severity and timing. But epidemics in Asia are far from over and several countries including China, Indonesia, and Vietnam have growing epidemics. Several factors affect the rate and magnitude of growth of HIV prevalence, but two of the most important are the size of the sex worker population and the frequency with which commercial sex occurs. In view of the present state of knowledge, even countries with low prevalence of infection might still have epidemics affecting a small percentage of the population. Once HIV infection has become established, growing needs for care and treatment are unavoidable and even the so-called prevention-successful countries of Thailand and Cambodia are seeing burgeoning care needs. The manifestations of HIV disease in the region are discussed with the aim of identifying key issues in medical management and care of HIV/AIDS. In particular, issues relevant to developing appropriate highly active antiretroviral treatment programmes in the region are discussed. Although access to antiretroviral therapy is increasing globally, making it work effectively while simultaneously expanding prevention programmes to stem the flow of new infections remains a real challenge in Asia. Genuine political interest and commitment are essential foundations for success, demanding advocacy at all levels to drive policy, mobilise sufficient resources, and take effective action.

Situational analysis of infant and young child nutrition policies and programmatic activities in Niger.

PubMed

Wuehler, Sara E; Biga Hassoumi, Abdoulazize

2011-04-01

Due to limited progress towards reducing mortality and malnutrition among children <5 years of age, an alliance of international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel,' starting with a situational analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of this analysis are to compile, analyse, and interpret available information on infant and child feeding and the nutrition situation of children <2 years of age in Niger, as one of the six targeted countries. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Niger were interviewed, and 90 documents were examined on: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of HIV, management of acute malnutrition, food security, and hygienic practices. The results reported are limited by the availability of documents for review. Mortality rates are on track to reaching the Millennium Development Goal to reduce mortality among young children by two-thirds by 2015, but there has been no change in undernutrition, and total mortality rates are still high among young children. Nearly all of the key IYCN topics were addressed, specifically or generally, in national policy documents, training materials, and programmes. A national nutrition council meets regularly to coordinate programme activities nationally. Many of the IYCN-related programmes are intended for national coverage, but few reach this coverage. Monitoring and impact evaluations were conducted on some programmes, but few of these reported on whether the specific IYCN components of the programme were implemented as designed or compared outcomes with non-intervention sites. Human resources have been identified as inadequate to fully carry out nutrition programmes in Niger. Due to these limitations, we could not confirm whether the lack of progress in reducing malnutrition was due to ineffective or inadequately implemented programmes, though both of these were likely contributors. The policy framework is well established for the promotion of optimal IYCN practices, but greater resources and capacity building are needed to: (i) increase human capacities to carry out nutrition programmes; (ii) expand and track the implementation of evidence-based programmes nationally; (iii) improve and carry out monitoring and evaluation that identify effective and ineffective programmes; and (iv) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

An assessment of the impact of the NHS Health Technology Assessment Programme.

PubMed

Hanney, S; Buxton, M; Green, C; Coulson, D; Raftery, J

2007-12-01

To consider how the impact of the NHS Health Technology Assessment (HTA) Programme should be measured. To determine what models are available and their strengths and weaknesses. To assess the impact of the first 10 years of the NHS HTA programme from its inception in 1993 to June 2003 and to identify the factors associated with HTA research that are making an impact. Main electronic databases from 1990 to June 2005. The documentation of the National Coordinating Centre for Health Technology Assessment (NCCHTA). Questionnaires to eligible researchers. Interviews with lead investigators. Case study documentation. A literature review of research programmes was carried out, the work of the NCCHTA was reviewed, lead researchers were surveyed and 16 detailed case studies were undertaken. Each case study was written up using the payback framework. A cross-case analysis informed the analysis of factors associated with achieving payback. Each case study was scored for impact before and after the interview to assess the gain in information due to the interview. The draft write-up of each study was checked with each respondent for accuracy and changed if necessary. The literature review identified a highly diverse literature but confirmed that the 'payback' framework pioneered by Buxton and Hanney was the most widely used and most appropriate model available. The review also confirmed that impact on knowledge generation was more easily quantified than that on policy, behaviour or especially health gain. The review of the included studies indicated a higher level of impact on policy than is often assumed to occur. The survey showed that data pertinent to payback exist and can be collected. The completed questionnaires showed that the HTA Programme had considerable impact in terms of publications, dissemination, policy and behaviour. It also showed, as expected, that different parts of the Programme had different impacts. The Technology Assessment Reports (TARs) for the National Institute for Health and Clinical Excellence (NICE) had the clearest impact on policy in the form of NICE guidance. Mean publications per project were 2.93 (1.98 excluding the monographs), above the level reported for other programmes. The case studies revealed the large diversity in the levels and forms of impacts and the ways in which they arise. All the NICE TARs and more than half of the other case studies had some impact on policy making at the national level whether through NICE, the National Screening Committee, the National Service Frameworks, professional bodies or the Department of Health. This underlines the importance of having a customer or 'receptor' body. A few case studies had very considerable impact in terms of knowledge production and in informing national and international policies. In some of these the principal investigator had prior expertise and/or a research record in the topic. The case studies confirmed the questionnaire responses but also showed how some projects led to further research. This study concluded that the HTA Programme has had considerable impact in terms of knowledge generation and perceived impact on policy and to some extent on practice. This high impact may have resulted partly from the HTA Programme's objectives, in that topics tend to be of relevance to the NHS and have policy customers. The required use of scientific methods, notably systematic reviews and trials, coupled with strict peer reviewing, may have helped projects publish in high-quality peer-reviewed journals. Further research should cover more detailed, comprehensive case studies, as well as enhancement of the 'payback framework'. A project that collated health research impact studies in an ongoing manner and analysed them in a consistent fashion would also be valuable.

Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.

PubMed

Anderson, Peter; Chisholm, Dan; Fuhr, Daniela C

2009-06-27

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

Delivering comprehensive home-based care programmes for HIV: a review of lessons learned and challenges ahead in the era of antiretroviral therapy.

PubMed

Wringe, Alison; Cataldo, Fabian; Stevenson, Nicola; Fakoya, Ade

2010-09-01

Home-based care (HBC) programmes in low- and middle-income countries have evolved over the course of the past two decades in response to the HIV epidemic and wider availability of antiretroviral therapy (ART). Evidence is emerging from small-scale and well-resourced studies that ART delivery can be effectively incorporated within HBC programmes. However, before this approach can be expanded, it is necessary to consider the lessons learned from implementing routine HBC programmes and to assess what conditions are required for their roll-out in the context of ART provision. In this paper, we review the literature on existing HBC programmes and consider the arguments for their expansion in the context of scaling up ART delivery. We develop a framework that draws on the underlying rationale for HBC and incorporates lessons learned from community health worker programmes. We then apply this framework to assess whether the necessary conditions are in place to effectively scale up HBC programmes in the ART era. We show that the most effective HBC programmes incorporate ongoing support, training and remuneration for their workers; are integrated into existing health systems; and involve local communities from the outset in programme planning and delivery. Although considerable commitment has so far been demonstrated to delivering comprehensive HBC programmes, their effectiveness is often hindered by weak linkages with other HIV services. Top-down donor policies and a lack of sustainable and consistent funding strategies represent a formidable threat to these programmes in the long term. The benefits of HBC programmes that incorporate ART care are unlikely to be replicated on a larger scale unless donors and policymakers address issues related to human resources, health service linkages and community preparedness. Innovative and sustainable funding policies are needed to support HBC programmes if they are to effectively complement national ART programmes in the long term.

[Public health competencies and contents in Spanish undergraduate medical degrees].

PubMed

Davó-Blanes, M Carmen; Vives-Cases, Carmen; Barrio-Fernández, José Luis; Porta, Miquel; Benavides, Fernando G; de Miguel, Ángel Gil

2016-01-01

To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into undergraduate medical degrees. The 2nd Forum of University Teachers was held at the Rey Juan Carlos University (Madrid, 11-12 December 2014). Twenty-four university professors and lecturers from 19 Spanish universities imparting medical degrees participated in the forum. They were distributed in three working groups during three working sessions. In the first session, they were asked to identify and classify core public health competencies for medical degrees. In the second, they were asked to propose public health contents for the identified competencies. In the third session, the participants organized these contents in thematic blocks. The results were discussed in distinct plenary sessions. The highest number of core competencies was identified in the activities related to the public health functions «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organised into five units: Concept of health, public health and its determinants; Epidemiology and health research; Determinants and health problems; Strategies, interventions and policies; and health systems, clinical and healthcare management. The public health core competencies and contents identified in this Forum may be considered as a starting point to improve and update public health training programmes for future medical professionals. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Using indicators to determine the contribution of human rights to public health efforts

PubMed Central

Ferguson, Laura

2009-01-01

Abstract There is general agreement on the need to integrate human rights into health policies and programmes, although there is still reluctance to go beyond rhetorical acknowledgement of their assumed significance. To determine the actual value of human rights for the effectiveness of public health efforts requires clarity about what their incorporation looks like in practice and how to assess their contribution. Despite the pervasive use of indicators in the public health field, indicators that specifically capture human rights concerns are not well developed and those that exist are inconsistently used. Even though “health and human rights indicators” are increasingly being constructed, it is often the case that health indicators are used to draw conclusions about some interaction between human rights and health; or that law and policy or other indicators, traditionally the domain of the human rights community, are used to make conclusions about health outcomes. To capture the added value that human rights bring to health, the differences in the contributions offered by these indicators need to be understood. To determine the value of different measures for advancing programme effectiveness, improving health outcomes and promoting human rights, requires questioning the intended purpose behind the construction of an indicator, who uses it, the kind of indicator it is, the extent to which it provides information about vulnerable populations, as well as how the data are collected and used. PMID:19784452

Transformation and Regulation: A Century of Continuity in Nursery School and Welfare Policy Rhetoric

ERIC Educational Resources Information Center

Read, Jane

2015-01-01

This article explores policy development for under-fives and its implementation in nursery schools in the first two decades of the twentieth century and draws parallels with current policy initiatives such as Sure Start and the "Troubled Families" programme. It interrogates how discourse on British racial health shaped policy and…

Assessing health impact assessment: multidisciplinary and international perspectives

PubMed Central

Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey, S; Bassett, M; Rehkopf, D; Miller, C

2003-01-01

Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world. PMID:12933768

Health-sector responses to address the impacts of climate change in Nepal.

PubMed

Dhimal, Meghnath; Dhimal, Mandira Lamichhane; Pote-Shrestha, Raja Ram; Groneberg, David A; Kuch, Ulrich

2017-09-01

Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme - Implementation Plan II (NHSP-IP 2) 2010-2015; the National Health Policy 2014; the National Health Sector Strategy 2015-2020 and its implementation plan (2016-2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016-2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.

Policy as Assemblage

ERIC Educational Resources Information Center

Gorur, Radhika

2011-01-01

In this article, the author tells the story of her search for appropriate tools to conceptualise policy work. She had set out to explore the relationship between the Programme for International Student Assessment (PISA) of the Organisation for Economic Co-operation and Development (OECD) and Australia's education policy, but early interview data…

Reduction of multiple pregnancies in the advanced maternal age population after implementation of an elective single embryo transfer policy coupled with enhanced embryo selection: pre- and post-intervention study

PubMed Central

Ubaldi, Filippo Maria; Capalbo, Antonio; Colamaria, Silvia; Ferrero, Susanna; Maggiulli, Roberta; Vajta, Gábor; Sapienza, Fabio; Cimadomo, Danilo; Giuliani, Maddalena; Gravotta, Enrica; Vaiarelli, Alberto; Rienzi, Laura

2015-01-01

STUDY QUESTION Is an elective single-embryo transfer (eSET) policy an efficient approach for women aged >35 years when embryo selection is enhanced via blastocyst culture and preimplantation genetic screening (PGS)? SUMMARY ANSWER Elective SET coupled with enhanced embryo selection using PGS in women older than 35 years reduced the multiple pregnancy rates while maintaining the cumulative success rate of the IVF programme. WHAT IS KNOWN ALREADY Multiple pregnancies mean an increased risk of premature birth and perinatal death and occur mainly in older patients when multiple embryos are transferred to increase the chance of pregnancy. A SET policy is usually recommended in cases of good prognosis patients, but no general consensus has been reached for SET application in the advanced maternal age (AMA) population, defined as women older than 35 years. Our objective was to evaluate the results in terms of efficacy, efficiency and safety of an eSET policy coupled with increased application of blastocyst culture and PGS for this population of patients in our IVF programme. STUDY DESIGN, SIZE, DURATION In January 2013, a multidisciplinary intervention involving optimization of embryo selection procedure and introduction of an eSET policy in an AMA population of women was implemented. This is a retrospective 4-year (January 2010–December 2013) pre- and post-intervention analysis, including 1161 and 499 patients in the pre- and post-intervention period, respectively. The primary outcome measures were the cumulative delivery rate (DR) per oocyte retrieval cycle and multiple DR. PARTICIPANTS/MATERIALS, SETTING, METHODS Surplus oocytes and/or embryos were vitrified during the entire study period. In the post-intervention period, all couples with good quality embryos and less than two previous implantation failures were offered eSET. Embryo selection was enhanced by blastocyst culture and PGS (blastocyst stage biopsy and 24-chromosomal screening). Elective SET was also applied in cryopreservation cycles. MAIN RESULTS AND THE ROLE OF CHANCE Patient and cycle characteristics were similar in the pre- and post-intervention groups [mean (SD) female age: 39.6 ± 2.1 and 39.4 ± 2.2 years; range 36–44] as assessed by logistic regression. A total of 1609 versus 574 oocyte retrievals, 937 versus 350 embryo warming and 138 versus 27 oocyte warming cycles were performed in the pre- and post-intervention periods, respectively, resulting in 1854 and 508 embryo transfers, respectively. In the post-intervention period, 289 cycles were blastocyst stage with (n = 182) or without PGS (n = 107). A mean (SD) number of 2.9 ± 1.1 (range 1–4) and 1.4 ± 0.8 (range 1–3) embryos were transferred pre- and post-intervention, respectively (P < 0.01) and similar cumulative clinical pregnancy rates per transfer and per cycle were obtained: 26.8, 30.9% and 29.7, 26.3%, respectively. The total DR per oocyte retrieval cycle (21.0 and 20.4% pre- and post-intervention, respectively) defined as efficacy was not affected by the intervention [odds ratio (OR) = 0.8, 95% confidence interval (CI) = 0.7–1.1; P = 0.23]. However, a significantly increased live birth rate per transferred embryo (defined as efficiency) was observed in the post-intervention group 17.0 versus 10.6% (P < 0.01). Multiple DRs decreased from 21.0 in the preintervention to 6.8% in the post-intervention group (OR = 0.3. 95% CI = 0.1–0.7; P < 0.01). LIMITATIONS, REASONS FOR CAUTION In this study, the suitability of SET was assessed in individual women on the basis of both clinical and embryological prognostic factors and was not standardized. For the described eSET strategy coupled with an enhanced embryo selection policy, an optimized culture system, cryopreservation and aneuploidy screening programme is necessary. WIDER IMPLICATIONS OF THE FINDINGS Owing to the increased maternal morbidity and perinatal complications related to multiple pregnancies, it is recommended to extend the eSET policy to the AMA population. As shown in this study, enhanced embryo selection procedures might allow a reduction in the number of embryos transferred and the number of transfers to be performed without affecting the total efficacy of the treatment but increasing efficiency and safety. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER None. PMID:26150408

The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study.

PubMed

Lundberg, Olle; Yngwe, Monica Aberg; Stjärne, Maria Kölegård; Elstad, Jon Ivar; Ferrarini, Tommy; Kangas, Olli; Norström, Thor; Palme, Joakim; Fritzell, Johan

2008-11-08

Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity. These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality. Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies. Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women. The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.

When Worlds Collide--Examining the Challenges Faced by Teacher Education Programmes Combining Professional Vocational Competence with Academic Study, Lessons from Further Education to Higher Education

ERIC Educational Resources Information Center

Shaw, Angela

2016-01-01

This paper examines the challenges faced by higher education institutions in designing, teaching and quality assuring programmes of study which, of necessity, must combine the gaining of professional vocational competence with academic study. The paper gives recognition to the policy framework in which these programmes fit--with particular…

Digital Reading in PISA 2012 and ICT Uses: How Do VET and General Education Students Perform? JRC Science for Policy Report

ERIC Educational Resources Information Center

Dinis da Costa, Patrícia; Araújo, Luísa

2016-01-01

The analyses presented in this report indicate that in several Member States (MS) 15-year-old students in vocational-oriented programmes (VET) perform better in digital reading than in print reading in PISA 2012. When differentiated by programme of study--VET versus general education programmes--VET students perform better in digital than in print…

Responding to excessive alcohol consumption in third-level (REACT): a study protocol.

PubMed

Davoren, Martin P; Calnan, Susan; Mulcahy, Judith; Lynch, Emily; Perry, Ivan J; Byrne, Michael

2018-05-11

Problem alcohol use is an ongoing, worldwide phenomenon of considerable concern. Throughout the past 20 years, national policies have noted the importance of students when tackling alcohol consumption. Considering alcohol is a multifaceted issue, a multi-component response is required to combat its excessive use. This protocol sets out the approach used for developing, implementing and evaluating the REACT (Responding to Excessive Alcohol Consumption in Third-level) Programme. This evaluation will provide the evidence base for programme development, implementation and improvement. Stage one involved defining the multi-component intervention. This was developed following a systematic review of existing literature and a Delphi-consensus workshop involving university students, staff and relevant stakeholders. Following this, the programme is being implemented across the Higher Education sector in Ireland. A number of Higher Education Institutes have declined the invitation to participate in the programme. These institutions will act as control sites. Each intervention site will have a steering committee whose membership will include a mix of students and academic and student service staff. This steering committee will report to the REACT research team on the implementation of mandatory and optional action points at local sites. An online cross-sectional study at baseline and two-years post intervention will be utilised to determine the impact of the REACT programme. The impact assessment will focus on (1) whether the intervention has reduced alcohol consumption among third-level students (2); whether the programme altered students attitudes toward alcohol and (3) whether the programme has decreased the second-hand effects associated with excessive consumption. Finally, qualitative research will focus on factors influencing the take-up and implementation of this programme as well as students' views on the initiative. Alcohol consumption has remained on the policy agenda at both national and international level over recent decades. Students are regularly among the highest alcohol consumers, yet university management and public policymakers struggle to tackle this burgeoning issue. The REACT Programme provides a structure to translate policy into practice for those seeking to reduce hazardous alcohol consumption and related harms among third-level students.

Influence of an Interdisciplinary Re-employment Programme Among Unemployed Persons with Mental Health Problems on Health, Social Participation and Paid Employment.

PubMed

Carlier, Bouwine E; Schuring, Merel; Burdorf, Alex

2018-03-01

Purpose To evaluate the influence of an interdisciplinary re-employment programme on labour force participation and perceived health among unemployed persons with common mental health problems. In addition, the influence of entering paid employment on self-rated physical health and mental health was investigated. Methods In this quasi-experimental study with 2 years follow up, 869 persons were enrolled after referral to an interdisciplinary re-employment programme (n = 380) or regular re-employment programme (n = 489). The propensity score technique was used to account for observed differences between the intervention and control group. The intervention programme was provided by an interdisciplinary team, consisting of mental health care professionals as well as employment specialists. Mental health problems were addressed through cognitive counselling and individual tailored job-search support was provided by an employment professional. Primary outcome measures were paid employment and voluntary work. Secondary outcome measures were self-rated mental and physical health, measured by the Short Form 12 Health Survey, and anxiety and depressive symptoms, measured by the Kessler Psychological Distress Scale. Changes in labour force participation and health were examined with repeated-measures logistic regression analyses by the generalized estimating equations method. Results The interdisciplinary re-employment programme did not have a positive influence on entering employment or physical or mental health among unemployed persons with mental health problems. After 2 years, 10% of the participants of the intervention programme worked fulltime, compared to 4% of the participants of the usual programmes (adjusted OR 1.65). The observed differences in labour force participation were not statistically significant. However, among persons who entered paid employment, physical health improved (+16%) and anxiety and depressive symptoms decreased (-15%), whereas health remained unchanged among persons who continued to be unemployed. Conclusions Policies to improve population health should take into account that promoting paid employment may be an effective intervention to improve health. It is recommended to invest in interdisciplinary re-employment programmes with a first place and train approach.

Developing a diabetes prevention education programme for community health-care workers in Thailand: formative findings.

PubMed

Sranacharoenpong, Kitti; Hanning, Rhona M

2011-10-01

The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs. Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable. Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings. Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the communities they serve. Ultimately, this should support chronic disease prevention in Thailand.

Improving participant selection in disease management programmes: insights gained from propensity score stratification.

PubMed

Linden, Ariel; Adams, John L

2008-10-01

While the randomized controlled trial (RCT) remains the gold-standard study design for evaluating treatment effect, outcomes researchers turn to powerful quasi-experimental designs when only observational studies can be conducted. Within these designs, propensity score matching is one of the most popular to evaluate disease management (DM) programme effectiveness. Given that DM programmes generally have a much smaller number of participants than non-participants in the population, propensity score matching will typically result in all or nearly all participants finding successful matches, while most of the non-participants in the population remain unmatched and thereby excluded from the analysis. By excluding data from the unmatched population, the effect of non-treatment in the remaining population with the disease is not captured. In the present study, we examine changes in hospitalization rates stratified by propensity score quintiles across the entire population allowing us to gain insight as to how well the programme chose its participants, or if the programme could have been effective on those individuals not explicitly targeted for the intervention. These data indicate the presence of regression to the mean, and suggest that the DM programme may be overly limited to only the highest strata when there is evidence of a potential benefit for those in all the lower strata as well.

The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: a sequential mixed methods evaluation.

PubMed

Carter, Tim; Callaghan, Patrick; Khalil, Elizabeth; Morres, Ioannis

2012-03-13

People with mental illness are more likely to suffer physical health problems than comparable populations who do not have mental illness. There is evidence to suggest that exercise, as well has having obvious physical benefits, also has positive effects on mental health. There is a distinct paucity of research testing its effects on young people seeking help for mental health issues. Additionally, it is generally found that compliance with prescribed exercise programmes is low. As such, encouraging young people to exercise at levels recommended by national guidelines may be unrealistic considering their struggle with mental health difficulties. It is proposed that an exercise intervention tailored to young people's preferred intensity may improve mental health outcomes, overall quality of life, and reduce exercise attrition rates. A sequential mixed methods design will be utilised to assess the effectiveness of an individually tailored exercise programme on the mental health outcomes of young people with depression. The mixed methods design incorporates a Randomised Controlled Trial (RCT), focus groups and interviews and an economic evaluation. 158 young people (14-17 years) recruited from primary care and voluntary services randomly allocated to either the intervention group or control group. Intervention group: PARTICIPANTS will undertake a 12 week exercise programme of 12 × 60 minutes of preferred intensity aerobic exercise receiving motivational coaching and support throughout. PARTICIPANTS will also be invited to attend focus groups and 1-1 interviews following completion of the exercise programme to illicit potential barriers facilitators to participation. PARTICIPANTS will receive treatment as usual. Depression using the Children's Depression Inventory 2 (CDI-2). Quality of Life (EQ-5D), physical fitness (Borg RPE scale, heart rate), incidents of self-harm, treatment received and compliance with treatment, and the cost effectiveness of the intervention. Outcome measures will be taken at baseline, post intervention and 6 month follow up. The results of this study will inform policy makers of the effectiveness of preferred intensity exercise on the mental health outcomes of young people with depression, the acceptability of such an intervention to this population and its cost effectiveness. ClinicalTrials.gov: NCT01474837.

NATIONAL POLICIES TO MEET THE CHALLENGE OF SUBSTANCE ABUSE : PROGRAMMES AND IMPLEMENTATION

PubMed Central

Malhotra, Anil; Mohan, Ashwin

2000-01-01

Drug abuse has become a growing issue of concern to humanity. India has a large consumer base of drug and alcohol abusers. This has serious repercussions in terms of morbidity & mortality. Hence the need for a national policy. In India, the Narcotic Drugs and Psychotropic Substances Act. 1985 (NDPS) provides the framework for drug abuse control in the country. A large number of measures have been undertaken as part of demand reduction activities. These include framing policies and programmes, setting up of centres, developing pilot projects, etc. However, the implementation still needs a lot to be desired. The efforts have not yet been streamlined and no revision of policies has taken place based on experience. This paper critically reviews the initiatives taken thus far to control drug abuse in our country. PMID:21407973

Involving young people in health promotion, research and policy-making: practical recommendations.

PubMed

Aceves-Martins, Magaly; Aleman-Diaz, Aixa Y; Giralt, Montse; Solà, Rosa

2018-05-18

Youth is a dynamic and complex transition period in life where many factors jeopardise its present and future health. Youth involvement enables young people to influence processes and decisions that affect them, leading to changes in themselves and their environment (e.g. peers, services, communities and policies); this strategy could be applied to improve health and prevent diseases. Nonetheless, scientific evidence of involving youth in health-related programmes is scarce. The aim of this paper is to describe youth involvement as a health promotion strategy and to compile practical recommendations for health promoters, researchers and policy-makers interested in successful involvement of young people in health-related programmes. These suggestions aim to encourage a positive working synergy between adults and youth during the development, implementation and evaluation of policies, research and/or health promotion efforts that target adolescents.

Best practice workplace HIV/AIDS programmes in South Africa: A review of case studies and lessons learned

PubMed Central

2009-01-01

ABSTRACT Background A group of experts attending a tripartite interregional meeting on best practices in HIV/AIDS workplace policies and programmes organised by the International Labour Organisation (ILO) in Geneva, Switzerland, identified 34 best practice workplace HIV programmes from across the world. Method The ten criteria that were used for reviewing best practice workplace HIV/AIDS programmes in South Africa include acceptability, accessibility, ethical soundness, perceived impact, relevance, appropriateness, innovativeness, efficiency, sustainability and replicability. Results More than one-third (35.3%) of the 34 best practice workplace interventions identified were found in businesses and industries in South Africa. This constitutes a significant and encouraging effort to deal with HIV/AIDS in the workplace. Approximately 16.7% of the best practice workplace HIV/AIDS interventions focused on policy and legal frameworks, 50% of these interventions focused on prevention, 16.7% provided links beyond the workplace and a further 16.7% were interventions that focused on knowledge and evidence. A third (33.3%) of practices were found in the mining industry, 16.7% in the motor industry, 16.7% from workers’ unions, and the rest (33.3%) were found in a sugar company, an electricity supply company, a pharmaceutical company and the ministry of Public Service and Administration. Conclusion It is encouraging that over one-third of all best practice workplace HIV interventions identified by the ILO experts were found in South Africa. The majority of these policies and programmes were focused on HIV prevention.

Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation.

PubMed

Graham, Ian D; Kothari, Anita; McCutcheon, Chris

2018-02-02

Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of research. With IKT, knowledge users work with researchers throughout the research process, starting with identification of the research question. Knowledge users represent those who would be able to use research results to inform their decisions (e.g. clinicians, managers, policy makers, patients/families and others). Stakeholders are increasingly interested in the idea that IKT generates greater and faster societal impact. Stakeholders are all those who are interested in the use of research results but may not necessarily use them for their own decision-making (e.g. governments, funders, researchers, health system managers and policy makers, patients and clinicians). Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. This paper presents a protocol for a programme of research testing the assumption that engaging the users of research in phases of its production leads to (a) greater appreciation of and capacity to use research; (b) the production of more relevant, useful and applicable research that results in greater impact; and (c) conditions under which it is more likely that research results will influence policy, managerial and clinical decision-making. The research programme will adopt an interdisciplinary, international, cross-sector approach, using multiple and mixed methods to reflect the complex and social nature of research partnerships. We will use ongoing and future natural IKT experiments as multiple cases to study IKT in depth, and we will take advantage of the team's existing relationships with provincial, national and international organizations. Case studies will be retrospective and prospective, and the 7-year grant period will enable longitudinal studies. The initiation of partnerships, funding processes, the research lifecycle and then outcomes/impacts post project will be studied in real time. These living laboratories will also allow testing of strategies to improve the efficiency and effectiveness of the IKT approach. This is the first interdisciplinary, systematic and programmatic research study on IKT. The research will provide scientific evidence on how to reliably and validly measure collaborative research partnerships and their impacts. The proposed research will build the science base for IKT, assess its relationship with research use and identify best practices and appropriate conditions for conducting IKT to achieve the greatest impact. It will also train and mentor the next generation of IKT researchers.

International Baccalaureate Diploma Programme: Examining College Readiness

ERIC Educational Resources Information Center

Conley, David; McGaughy, Charis; Davis-Molin, Whitney; Farkas, Rachel; Fukuda, Erin

2014-01-01

The International Baccalaureate (IB) works with schools, governments, and international organizations to develop challenging programmes of international education and rigorous assessment. This three-phase study prepared by the Educational Policy Improvement Center (EPIC) on behalf of the International Baccalaureate Organization explored the impact…

Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity.

PubMed

Beeres, Dorien T; Cornish, Darren; Vonk, Machiel; Ravensbergen, Sofanne J; Maeckelberghe, Els L M; Boele Van Hensbroek, Pieter; Stienstra, Ymkje

2018-03-02

With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition 'to return good in proportion to the good we receive, and to make reparations for the harm we have done', as a mid-level principle in infectious disease screening policies. More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers' participation and the benefits for the control of public health. The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.

Policy and Advocacy Concepts and Processes: Innovative Content in Early Childhood Teacher Education

ERIC Educational Resources Information Center

Hollingsworth, Heidi L.; Knight-McKenna, Mary; Bryan, Ren

2016-01-01

Knowledge and skills regarding policy and advocacy are important expectations for today's early childhood workforce, yet policy and advocacy content and processes have not traditionally been emphasized in teacher preparation programmes. This article describes an innovative undergraduate course that goes beyond traditional foci on developmental…

Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries.

PubMed

Petersen, Inge; Evans-Lacko, Sara; Semrau, Maya; Barry, Margaret M; Chisholm, Dan; Gronholm, Petra; Egbe, Catherine O; Thornicroft, Graham

2016-01-01

In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify "best practice" and "good practice" interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs. A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify "best practice" at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising "good practice". At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate "best practice" interventions with sufficient evidence from "good practice" interventions with limited but promising evidence. At the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered "best practice". Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as "good practice". At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as "best practice". The following were all identified as "good practice": Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2-14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders. Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral engagement and the need for further research on interventions at these levels in LMICs is highlighted.

Private Practitioners' Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State.

PubMed

Salve, Solomon; Sheikh, Kabir; Porter, John Dh

2016-05-08

Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector's dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as 'partners with the TB programme.' Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A population based study comparing changes in rotavirus burden on the Island of Ireland between a highly vaccinated population and an unvaccinated population.

PubMed

Armstrong, Gillian; Gallagher, Naomh; Cabrey, Paul; Graham, Adele M; McKeown, Paul J; Jackson, Sarah; Dallat, Mary; Smithson, Richard D

2016-09-07

Rotavirus infection is a leading cause of gastroenteritis in infants and children globally. Reductions in rotavirus activity have been observed following introduction of rotavirus vaccination programmes, however a reductions have also been reported in some unvaccinated countries. The Island of Ireland incorporates the two jurisdictions Northern Ireland (NI) and the Republic of Ireland (IE). Both have similarities in climate, demography, morbidity and mortality but distinct health administrations and vaccination policies. Rotarix was added to the childhood immunisation programme in NI on the 1 July 2013. IE have not introduced routine rotavirus vaccination to date. The aim of this population based ecological study was to evaluate the impact of the rotavirus vaccine on burden of rotavirus disease in NI, and to compare with IE as an unvaccinated control population. This will help determine if the changes seen were due to the rotavirus vaccine, or due to confounding factors. A number of population based measures of disease burden were compared in both jurisdictions pre-vaccine (six years; 2007/08-2012/13) and post-vaccine (two years; 2013/14-2014/15). The data sources included national rotavirus surveillance data based on laboratory reports/notifications; hospital admission data; and notifications of gastroenteritis in under 2year olds. In the post-vaccination period, rotavirus incidence in NI dropped by 54% while in IE it increased by 19% compared to the pre-vaccine period. Notifications of gastroenteritis in under 2s in NI declined by 53% and hospital admissions in under 5year olds in NI declined by 40% in the post vaccine period. This natural experiment demonstrated a significant reduction in rotavirus disease activity post-vaccine introduction in NI with associated reductions in healthcare utilisation, with a concurrent increase in rotavirus disease activity in the non-vaccinated population in IE. These findings support rotavirus vaccination as an effective measure to reduce childhood morbidity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Income inequality in uptake of voluntary versus organised breast cancer screening: evidence from the British Household Panel Survey.

PubMed

Carney, Patricia; O'Neill, Ciaran

2018-02-14

This paper measures income-related inequality in uptake of breast cancer screening among women before and after a policy change to extend the screening programme to women aged 65 to 70. Prior to programme expansion women aged 50 to 64 were invited for screening under the national cancer screening programme in England and Wales whereas women in the 65 to 70 age cohort could elect to be screened by personally organising a screen. This will give a deeper insight into the nature of inequality in screening and the impact of policies aimed at widening the access related to age on inequality of uptake. Taking advantage of this natural experiment, inequality is quantified across the different age cohorts and time periods with the use of concentration indices (CI). Using data from the British Household Panel Survey, information on screening attendance, equivalised household income and age was taken for the three years prior to the programme expansion and the three years immediately following the policy change. Results show that following the expansion, inequality significantly reduced for the 50-64 age group, prior to the expansion there was a pro-rich inequality in screening uptake. There is also evidence of a reduction in income inequality in screening uptake among those aged 65 to 70 and an increase in the number of women attending screening from this older age cohort. This indicates that an organised breast screening programme is likely to reduce income related inequality over a screening programme where women must organise their own screen. This is important when breast screening is one of the main methods used to detect breast cancer at an earlier stage which improves outcomes for women and reduces treatment costs.

The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis

PubMed Central

van Ginneken, Nadja; Lewin, Simon; Berridge, Virginia

2010-01-01

There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s–1994) – a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care. Thirteen oral history interviews and eight witness seminars were conducted in South Africa in April 2008 with founders and CHWs from these earlier programmes. These data were triangulated with written primary sources and analysed using thematic content analysis. The study suggests that 1970s–1990s CHW programmes were seen as innovative, responsive, comprehensive and empowering for staff and communities, a focus which respondents felt was lost within current programmes. The growth of these earlier projects was underpinned by the struggle against apartheid. Respondents felt that the more technical focus of current CHW programmes under-utilise a valuable human resource which previously had a much wider social and health impact. These prior experiences and lessons learned could usefully inform policy-making frameworks for CHWs in South Africa today. PMID:20638169

Good on paper: the gap between programme theory and real-world context in Pakistan's Community Midwife programme.

PubMed

Mumtaz, Z; Levay, A; Bhatti, A; Salway, S

2015-01-01

To understand why skilled birth attendance-an acknowledged strategy for reducing maternal deaths-has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory-driven approach to evaluating implementation of maternal healthcare interventions. Implementation research was conducted using an institutional ethnographic approach. National programme and local community levels in Pakistan. Observations, focus group discussions, and in-depth interviews were conducted with 38 Community Midwives (CMWs), 20 policymakers, 45 healthcare providers and 136 community members. A critical policy document review was conducted. National and local level data were brought together. Alignment of programme theory with real-world practice. Data revealed gaps between programme theory, assumptions and reality on the ground. The design of the programme failed to take into account: (1) the incongruity between the role of a midwife and dominant class and gendered norms that devalue such a role; (2) market and consumer behaviour that prevented CMWs from establishing private practices; (3) the complexity of public-private sector cooperation. Uniform deployment policies failed to consider existing provider density and geography. Greater attention to programme theory and the 'real-world' setting during design of maternal health strategies is needed to achieve consistent results in different contexts. © 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis.

PubMed

van Ginneken, Nadja; Lewin, Simon; Berridge, Virginia

2010-09-01

There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s-1994) - a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care. Thirteen oral history interviews and eight witness seminars were conducted in South Africa in April 2008 with founders and CHWs from these earlier programmes. These data were triangulated with written primary sources and analysed using thematic content analysis. The study suggests that 1970s-1990s CHW programmes were seen as innovative, responsive, comprehensive and empowering for staff and communities, a focus which respondents felt was lost within current programmes. The growth of these earlier projects was underpinned by the struggle against apartheid. Respondents felt that the more technical focus of current CHW programmes under-utilise a valuable human resource which previously had a much wider social and health impact. These prior experiences and lessons learned could usefully inform policy-making frameworks for CHWs in South Africa today. Copyright 2010 Elsevier Ltd. All rights reserved.

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies.

PubMed

Uday, Suma; Högler, Wolfgang

2017-08-01

Nutritional rickets and osteomalacia are common in dark-skinned and migrant populations. Their global incidence is rising due to changing population demographics, failing prevention policies and missing implementation strategies. The calcium deprivation spectrum has hypocalcaemic (seizures, tetany and dilated cardiomyopathy) and late hypophosphataemic (rickets, osteomalacia and muscle weakness) complications. This article reviews sustainable prevention strategies and identifies areas for future research. The global rickets consensus recognises the equal contribution of vitamin D and dietary calcium in the causation of calcium deprivation and provides a three stage categorisation for sufficiency, insufficiency and deficiency. For rickets prevention, 400 IU daily is recommended for all infants from birth and 600 IU in pregnancy, alongside monitoring in antenatal and child health surveillance programmes. High-risk populations require lifelong supplementation and food fortification with vitamin D or calcium. Future research should identify the true prevalence of rickets and osteomalacia, their role in bone fragility and infant mortality, and best screening and public health prevention tools.

A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

PubMed

Bellows, Ben W; Conlon, Claudia M; Higgs, Elizabeth S; Townsend, John W; Nahed, Matta G; Cavanaugh, Karen; Grainger, Corinne G; Okal, Jerry; Gorter, Anna C

2013-12-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes

PubMed Central

Conlon, Claudia M.; Higgs, Elizabeth S.; Townsend, John W.; Nahed, Matta G.; Cavanaugh, Karen; Grainger, Corinne G.; Okal, Jerry; Gorter, Anna C.

2013-01-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues.

PubMed

Hall, A E; Chowdhury, S; Hallowell, N; Pashayan, N; Dent, T; Pharoah, P; Burton, H

2014-06-01

The identification of common genetic variants associated with common cancers including breast, prostate and ovarian cancers would allow population stratification by genotype to effectively target screening and treatment. As scientific, clinical and economic evidence mounts there will be increasing pressure for risk-stratified screening programmes to be implemented. This paper reviews some of the main ethical, legal and social issues (ELSI) raised by the introduction of genotyping into risk-stratified screening programmes, in terms of Beauchamp and Childress's four principles of biomedical ethics--respect for autonomy, non-maleficence, beneficence and justice. Two alternative approaches to data collection, storage, communication and consent are used to exemplify the ELSI issues that are likely to be raised. Ultimately, the provision of risk-stratified screening using genotyping raises fundamental questions about respective roles of individuals, healthcare providers and the state in organizing or mandating such programmes, and the principles, which underpin their provision, particularly the requirement for distributive justice. The scope and breadth of these issues suggest that ELSI relating to risk-stratified screening will become increasingly important for policy-makers, healthcare professionals and a wide diversity of stakeholders. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.

What supervisors and universities can do to enhance doctoral student experience (and how they can help themselves).

PubMed

Duke, Dawn C; Denicolo, Pam M

2017-05-01

Over the past two decades, there has been a flurry of government papers and policy reports worldwide calling for increased number and diversity of doctoral researchers and a broadening of the curriculum to meet the developing needs of respective national 'knowledge-driven' economies. This has been followed by position papers and best practice examples of employability skills development in boundary-crossing doctoral programmes, especially in response to these initiatives. However, there is a disassociation between this ample literature expounding the new doctorate with its broader remit, inclusivity and production of 'industry-ready' graduates and the comparatively sparse literature on the doctoral candidates' experiences of their programmes and career readiness. Within this review, we briefly outline international government initiatives and examples of the responses by Life Science and Biomedical doctoral programmes to address these various challenges. Furthermore, we explore the recent literature on the lived experience of doctoral researchers by examining their perception of the recent changes to the research context to make recommendations for universities and supervisors on how to better support an ever more diverse doctoral population for a wide range of career opportunities. Examples of how doctoral researchers themselves can make the best of currently available opportunities are also provided. © FEMS 2017.

Knowledge of oral cancer risk factors amongst high-risk Australians: findings from the LESIONS programme.

PubMed

Dost, F; Do, L; Farah, C S

2016-12-01

Patient awareness of risk factors associated with cancer has been shown to increase patient presentation for screening and early detection. This study aimed to identify the level of awareness of oral cancer risk factors in a high risk Australian population. Participants were recruited from the LESIONS programme between April 2012 and April 2014. Demographics were collected via semi-structured interview. A self-administered questionnaire was provided, listing a number of possible oral cancer risk factors. Participants were requested to indicate their level of agreement on a three-point scale. Bivariate and multivariable analysis was performed. A total of 1498 participants took part in the LESIONS programme and were invited to complete the questionnaire. The most common risk factors thought to be associated with oral cancer were smoking (87.5%), poor oral hygiene (67.9%) and family history (61.1%). Only 50.2% of respondents were aware of alcohol consumption as a risk factor. While most participants were aware of the association between smoking and oral cancer, only half were aware of the significant risk alcohol consumption poses. A significant portion of participants also held a number of inaccurate beliefs in relation to oral cancer risk. These findings can benefit both clinicians and public health policy makers in targeting oral cancer education. © 2016 Australian Dental Association.

What supervisors and universities can do to enhance doctoral student experience (and how they can help themselves)

PubMed Central

Denicolo, Pam M.

2017-01-01

Abstract Over the past two decades, there has been a flurry of government papers and policy reports worldwide calling for increased number and diversity of doctoral researchers and a broadening of the curriculum to meet the developing needs of respective national ‘knowledge-driven’ economies. This has been followed by position papers and best practice examples of employability skills development in boundary-crossing doctoral programmes, especially in response to these initiatives. However, there is a disassociation between this ample literature expounding the new doctorate with its broader remit, inclusivity and production of ‘industry-ready’ graduates and the comparatively sparse literature on the doctoral candidates’ experiences of their programmes and career readiness. Within this review, we briefly outline international government initiatives and examples of the responses by Life Science and Biomedical doctoral programmes to address these various challenges. Furthermore, we explore the recent literature on the lived experience of doctoral researchers by examining their perception of the recent changes to the research context to make recommendations for universities and supervisors on how to better support an ever more diverse doctoral population for a wide range of career opportunities. Examples of how doctoral researchers themselves can make the best of currently available opportunities are also provided. PMID:28472431

The Community Connection Model: implementation of best evidence into practice for self-management of chronic diseases.

PubMed

Liddy, C; Johnston, S; Irving, H; Nash, K

2013-06-01

With chronic diseases becoming an increasing burden for healthcare systems worldwide, self-management support has gained traction in many health regions and organizations. However, the real-world application of the findings from clinical trials into actual community programming is not self-evident. The aim of this study was to present a model of programme implementation, namely the Community Connection Model. The process of implementing a chronic disease self-management programme has been documented in detail from its initial inception through to a sustainable programme. This account includes a description of the strategic activities undertaken (e.g. alignment with local policy and the formation of community partnerships) and the specific steps taken on the path to programme implementation (e.g. a scoping literature review, an environmental scan and a pilot programme with an evaluation component). Reflection on this case example suggests that a cognizance of the interactions between policy, partnership, planning and programme could act as a useful tool to guide programme implementation, evaluation and sustainability. Multiple types of self-management support have been implemented (as part of the Living Health Champlain programme), and are being evaluated and adapted in response to new evidence, shifting priorities and direction from more partners. The widespread access means that self-management support programmes are becoming part of the culture of care in the study region. Establishing a connection around an important health problem, ensuring active partnerships, adequate planning and early implementation of a programme grounded on the principles of applying best-available evidence can lead to successful solutions. The Community Connection Model is proposed as a way of conceptualizing these processes. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

European commission research on stratospheric ozone depletion

NASA Astrophysics Data System (ADS)

Amanatidis, G. T.; Ott, H.

1995-02-01

The research policy of the European Commission (EC) on the stratospheric ozone depletion, which is implemented through the ENVIRONMENT Programme is described. The strategy of this stratospheric ozone research, which is developed to address the open scientific questions, requires a coordinated and balanced programme which is based on long term measurements, process studies at regional or global scale, laboratory studies, continuous and accurate measurements of ultraviolet (UV) radiation and development of instrumentation. These research activities, whenever necessary, take form of extensive and coordinated experiments (EASOE 1991/92, SESAME 1994-95), while the overall objective is to provide a firm scientific basis for future European Union (EU) policy actions in this area. Finally, priorities which have been identified for future research in the ENVIRONMENT and CLIMATE Programme (1994-1998) are also detailed.

"Troops to Teachers": Implications for the Coalition Government's Approach to Education Policy and Pedagogical Beliefs and Practice

ERIC Educational Resources Information Center

Tipping, Alan

2013-01-01

On taking power the coalition government embarked on what many commentators believe is a radical programme of public policy reform. Under Michael Gove, education policy has become totemic to those arguing that Britain's classrooms are mired in academic mediocrity and behavioural failure. One policy response by the government has been to propose…

Television programmes - Communication theory and policies

ERIC Educational Resources Information Center

Nordenstreng, Kaarle

1974-01-01

This thesis - together with the previous one related with the comprehension of messages - emphasises the importance of materialistic considerations (materialism in the philosophical sense of the term) in mass communication policies and also communication research. (Author)

Use and outcomes of targeted therapies in early and metastatic HER2-positive breast cancer in Australia: protocol detailing observations in a whole of population cohort

PubMed Central

Daniels, Benjamin; Lord, Sarah J; Kiely, Belinda E; Houssami, Nehmat; Haywood, Philip; Lu, Christine Y; Ward, Robyn L; Pearson, Sallie-Anne

2017-01-01

Background The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) has changed dramatically with the introduction and widespread use of HER2-targeted therapies. However, there is relatively limited real-world information on patterns of use, effectiveness and safety in whole of population cohorts. The research programme detailed in this protocol will generate evidence on the prescribing patterns, safety monitoring and outcomes of patients with BC treated with HER2-targeted therapies in Australia. Methods/design Our ongoing research programme will involve a series of retrospective cohort studies that include every patient accessing Commonwealth-funded HER2-targeted therapies for the treatment of early BC and advanced BC in Australia. At the time of writing, our cohorts consist of 11 406 patients with early BC and 5631 with advanced BC who accessed trastuzumab and lapatinib between 2001 and 2014. Pertuzumab and trastuzumab emtansine were publicly funded for metastatic BC in 2015, and future data updates will include patients accessing these medicines. We will use dispensing claims for cancer and other medicines, medical service claims and demographics data for each patient accessing HER2-targeted therapies to undertake this research. Ethics and dissemination Ethics approval has been granted by the Population Health Service Research Ethics Committee and data access approval has been granted by the Australian Department of Human Services (DHS) External Review Evaluation Committee. Our findings will be reported in peer-reviewed publications, conference presentations and policy forums. By providing detailed information on the use and outcomes associated with HER2-targeted therapies in a national cohort treated in routine clinical care, our research programme will better inform clinicians and patients about the real-world use of these treatments and will assist third-party payers to better understand the use and economic costs of these treatments. PMID:28119394

Adult Education and Indigenous People: Addressing Gender in Policy and Practice

ERIC Educational Resources Information Center

Rao, Nitya; Robinson-Pant, Anna

2006-01-01

Adult education programmes developed for or by indigenous communities rarely seem to have addressed gender inequalities. Yet, compared to mainstream adult educational interventions promoting instrumental approaches to "functional literacy", such programmes often appear highly politicised, starting from a standpoint of promoting…

Continental Drift

ERIC Educational Resources Information Center

Field, John

2012-01-01

Adult learning has benefited from the visibility and profile of lifelong learning across a range of European policy areas. The overall profile of adult learning benefited enormously from the European Commission's decision to group all its education and training programmes together under the brand of the "Lifelong Learning Programme." The…

Optimizing adherence to antiretroviral therapy

PubMed Central

Sahay, Seema; Reddy, K. Srikanth; Dhayarkar, Sampada

2011-01-01

HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested. PMID:22310817

Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.

PubMed

Soban, Lynn M; Kim, Linda; Yuan, Anita H; Miltner, Rebecca S

2017-09-01

To describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Comprehensive pressure ulcer programmes include nursing interventions such as use of a risk assessment tool and organisational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programmes. Data were collected by an e-mail survey to all chief nursing officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarise survey responses and evaluate relationships between some variables. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalised within individual hospitals. Organisational strategies to support implementation of pressure ulcer preventive programmes are often not optimally operationalised to achieve consistent, sustainable performance. The results of the present study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Policy Support and Resources Mobilization for the National Schistosomiasis Control Programme in The People's Republic of China.

PubMed

Zhu, H; Yap, P; Utzinger, J; Jia, T-W; Li, S-Z; Huang, X-B; Cai, S-X

2016-01-01

Schistosomiasis remains a public health problem in many developing countries around the world. After the founding of The People's Republic of China, from 1949 till date, all levels of government, from central to local, have been attaching great importance to schistosomiasis control in The People's Republic of China. With considerable policy support and resources mobilization, the national schistosomiasis control programmes have been implemented during the past 65years. Here, we summarize the successful experience of schistosomiasis control during the process. Recommendations for the future management of the Chinese national schistosomiasis elimination programme are put forward after considering the remaining challenges, shortcomings and lessons learnt from 65years of schistosomiasis control drives in The People's Republic of China. They will help to sustain past achievements, foster the attainment of the ultimate goal of schistosomiasis elimination for the country and provide reference for schistosomiasis control programme in other countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Indonesia's road to universal health coverage: a political journey.

PubMed

Pisani, Elizabeth; Olivier Kok, Maarten; Nugroho, Kharisma

2017-03-01

In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns – different groups obtained access to healthcare as their socio-political importance grew. A major inflection point occurred following the Asian financial crisis of 1997. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC became an electoral asset, moving up the political agenda. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them. The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. Specific drivers of success and failure should be taken into account when scaling UHC to the national level. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward to achieve sustainable UHC in Indonesia.

Academic challenges and positive aspects: perceptions of male nursing students.

PubMed

Abushaikha, L; Mahadeen, A; AbdelKader, R; Nabolsi, M

2014-06-01

Nursing shortage remains a global issue that emphasizes the need for both male and female nurses. Understanding the educational experiences of male nursing students may help in recruiting and retaining male nurses in the nursing profession. The aim of this study was to explore the challenges and positive aspects that undergraduate male nursing students encounter during the course of their study. A qualitative research design using inductive content analysis approach was used to explore perceptions of 20 undergraduate male nursing students in a baccalaureate nursing programme at a major public university in Jordan. Content analysis revealed two major themes: challenges (academic difficulties, biased policies, no social life, negative views of nursing and negative self-view) and positive aspects (personal benefits of studying nursing, every home need a nurse and nursing is a science). The findings added new insights and knowledge regarding the educational experiences of undergraduate male nursing students in a developing country, which is an understudied population. Understanding the challenges and positive aspects of nursing education from the perspectives of undergraduate male nursing students may help nursing educators better understand their students' educational experiences and help clarify their roles and responsibilities in dealing with these issues. Nursing as a career should continue to be a viable choice for both male and female students to address global nursing shortages. This can be ensured by decreasing challenges and supporting positive aspects that nursing students face during their nursing education. Higher education policy makers can use the findings of this study to appreciate the challenges that university students face. They can also reconsider existing policies that may hinder the acceptance of male student into nursing programmes and contribute to educational challenges. © 2014 International Council of Nurses.

Putting newborn hearing screening on the political agenda in Belgium: local initiatives toward a community programme – a qualitative study

PubMed Central

2014-01-01

Background The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium. Methods A qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model’s three streams. Results The political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction. Conclusions The advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model. PMID:24986647

Putting newborn hearing screening on the political agenda in Belgium: local initiatives toward a community programme - a qualitative study.

PubMed

Vos, Bénédicte; Lagasse, Raphaël; Levêque, Alain

2014-07-01

The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium. A qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model's three streams. The political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction. The advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model.

Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system.

PubMed

Maher, Dermot

2010-07-05

The global financial crisis threatens global health, particularly exacerbating diseases of inequality, e.g. HIV/AIDS, and diseases of poverty, e.g. tuberculosis. The aim of this paper is to reconsider established practices and policies for HIV and tuberculosis epidemic control, aiming at delivering better results and value for money. This may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. HIV and tuberculosis share many similarities in terms of their disease burden and the recommended stratagems for their control. HIV and tuberculosis programmes implement similar sorts of control activities, e.g. case finding and treatment, which depend for success on generic health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, and financing. However, the current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens), drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens), research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy development and scaling up interventions, and identify ways of joint planning and joint funding of integrated delivery as part of strengthened health systems. As both a danger and an opportunity, the global financial crisis may entail disaster or recovery for global health sector efforts for HIV and tuberculosis epidemic control. Review of policies and progress in control paves the way for identification of synergies between the two programmes, within strengthened health services. The silver lining in the global economic crisis could be better control of the HIV and tuberculosis epidemics, better overall health system performance and outcomes, and better value for money.

Breast cancer and cervical cancer prevention programmes carried out by local government units in Poland in 2009-2014.

PubMed

Augustynowicz, Anna; Czerw, Aleksandra; Borowska, Mariola; Fronczak, Adam; Deptała, Andrzej

2018-04-24

In 2014 the standardised incidence rate for breast cancer in Poland reached 51.6/100,000, while the mortality rate reached 14.8/100,000. The incidence rate for breast cancer in the EU was 106.6/100,000, the mortality rate - 22.4/100,000. In 2014 the incidence rate for cervical cancer in Poland was 8.8/100,000, the mortality rate - 4.5/100,000. The incidence rate in the EU was 11.3/100,000 and the mortality rate - 3.7/100,000. The aim of the paper was to establish the number of health policy programmes concerned with breast cancer and cervical cancer in women carried out in 2009-2014 by local government units, with specification of the type of programme, type of local government units that carried out the programmes and the costs of implementation of the programmes. The study was based on a desk research. The analysis covered data included in annual reports submitted by voivodes to Minister of Health, concerning health policy programmes implemented by local government units in 2009-2014. The greatest number of programmes concerned with prevention of breast cancer and cervical cancer were implemented in municipalities, followed by counties and finally - self-governed voivodeships. The number of programmes concerned with primary prevention was three times smaller (656) than the number of programmes concerned with secondary prevention (2,229). The greatest number of primary prevention programmes were implemented in Dolnośląskie, Wielkopolskie and Mazowieckie Voivodeships, and the greatest number of secondary prevention programmes - in Wielkopolskie, Mazowieckie and Zachodniopomorskie Voivodeships. It was found that the number of programmes implemented by particular local government units and the financial resources employed in the implementation of the programmes were different. It is probable that some of the initiatives of local government units related to secondary prevention coincide with the actions undertaken under the National Programme for Fighting Cancer. The entities that carry out breast cancer and cervical cancer prevention programmes need to coordinate their actions.

Women and tobacco: moving from policy to action.

PubMed Central

Ernster, V.; Kaufman, N.; Nichter, M.; Samet, J.; Yoon, S. Y.

2000-01-01

A gender perspective contributes to a better understanding of the epidemiological trends, social marketing strategies, economic policies, and international actions relating to women and the tobacco epidemic. Evidence is provided in this article for the negative impact of tobacco use by women and of passive smoking on the health of women and children. Use of tobacco by women is increasing and this is related to the tobacco industry's aggressive advertising, sponsorship and promotion strategies. Policy directions are proposed in this article. At all levels, a multi-pronged strategy--including changes in legislation and fiscal policies, improvements in gender-sensitive health services, and cessation programmes--should be considered. Much more gender-specific research on tobacco use is needed, particularly in developing countries. Women's empowerment and leadership should be at the centre of all tobacco control efforts and are essential for the success of national programmes and the recently introduced Framework Convention on Tobacco Control. PMID:10994262

Women and tobacco: moving from policy to action.

PubMed

Ernster, V; Kaufman, N; Nichter, M; Samet, J; Yoon, S Y

2000-01-01

A gender perspective contributes to a better understanding of the epidemiological trends, social marketing strategies, economic policies, and international actions relating to women and the tobacco epidemic. Evidence is provided in this article for the negative impact of tobacco use by women and of passive smoking on the health of women and children. Use of tobacco by women is increasing and this is related to the tobacco industry's aggressive advertising, sponsorship and promotion strategies. Policy directions are proposed in this article. At all levels, a multi-pronged strategy--including changes in legislation and fiscal policies, improvements in gender-sensitive health services, and cessation programmes--should be considered. Much more gender-specific research on tobacco use is needed, particularly in developing countries. Women's empowerment and leadership should be at the centre of all tobacco control efforts and are essential for the success of national programmes and the recently introduced Framework Convention on Tobacco Control.

Analysis of a government policy to address nursing shortage and nursing education quality.

PubMed

Abhicharttibutra, K; Kunaviktikul, W; Turale, S; Wichaikhum, O-A; Srisuphan, W

2017-03-01

A well-educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies. Describe policy-making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality. A qualitative study employing Longest's model to examine policy-making processes. Data were obtained from 28 in-depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data. Three policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities. Not all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses' abilities and need to be involved in policy. Nurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand. Lessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy-making table to try to reduce nursing shortages, and enhance practice and education environments. © 2016 International Council of Nurses.

Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?

PubMed

Gartner, Coral E; Barendregt, Jan J; Wallace, Angela; Hall, Wayne D

2012-04-01

We used epidemiological modelling to assess whether nicotine vaccines would be a cost-effective way of preventing smoking uptake in adolescents. We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; life-time sex-specific disability-adjusted life years lived for cohorts of 100,000 smokers and non-smokers; government data on the costs of delivering a vaccination programme by general practitioners; and a range of plausible and optimistic estimates of vaccine cost, efficacy and immune response rates based on clinical trial results. We first estimated the smoking uptake rates for Australians aged 12-19 years. We then used these estimates to predict the expected smoking prevalence in a birth cohort aged 12 in 2003 by age 20 under (i) current policy and (ii) different vaccination scenarios that varied in cost, initial vaccination uptake, yearly re-vaccination rates, efficacy and a favourable vaccine immune response rate. Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44,431 [95% confidence interval (CI) $40,023-49,250]. This increased to $296,019 (95% CI $252,307-$355,930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario. A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Challenges for Academic Accreditation: The UK Experience

ERIC Educational Resources Information Center

Shearman, Richard; Seddon, Deborah

2010-01-01

Several factors (government policy, demographic trends, employer pressure) are leading to new forms of degree programmes in UK universities. The government is strongly encouraging engagement between universities and employers. Work-based learning is increasingly found in first and second cycle programmes, along with modules designed by employers…

An Integrated Approach to Environmental Education: A Case Study

ERIC Educational Resources Information Center

du Preez, Nicolaas P.; Mohr-Swart, Maryna

2004-01-01

In 1994, the Executive Management Committee (EMC) of Technikon Pretoria took a strategic decision to develop educational programmes in environmental management and sustainable development. The EMC also decided to integrate these programmes with the development and implementation of an environmental management policy for Technikon Pretoria. This…

Scientific Literacy and Student Attitudes: Perspectives from PISA 2006 Science

ERIC Educational Resources Information Center

Bybee, Rodger; McCrae, Barry

2011-01-01

International assessments provide important knowledge about science education and help inform decisions about policies, programmes, and practices in participating countries. In 2006, science was the primary domain for the Programme for International Student Assessment (PISA), supported by the Organisation for Economic Cooperation and Development…

Ethics, Education Policy and Research: The Phonics Question Reconsidered

ERIC Educational Resources Information Center

Ellis, Sue; Moss, Gemma

2014-01-01

This paper argues that direct control of the early years literacy curriculum recently exercised by politicians in England has made the boundaries between research, policy and practice increasingly fragile. It describes how policy came to focus most effort on the use of synthetic phonics programmes in the early years. It examines why the…

Organisational Factors Affecting Policy and Programme Decision Making in a Public Health Policy Environment

ERIC Educational Resources Information Center

Zardo, Pauline; Collie, Alex; Livingstone, Charles

2015-01-01

Organisational factors can affect the success of interventions aimed at increasing research use. Research is needed to identify organisational factors affecting research use in specific public health policy contexts. Qualitative interviews with decision makers from a specific public health context identified a range of organisational factors that…

"Representing Your Country": Scotland, PISA and New Spatialities of Educational Governance

ERIC Educational Resources Information Center

Lingard, Bob; Sellar, Sam

2014-01-01

This paper focuses on the rescaling and re-spatialization of policy and governance in education, including the constitution of a global education policy field. It deals with the changing education policy work of the OECD, particularly the influential Programme for International Student Assessment (PISA). We argue that PISA has become the most…

Interrogating the Continuing Professional Development Policy Framework in Ethiopia: A Critical Discourse Analysis

ERIC Educational Resources Information Center

Akalu, Girmaw Abebe

2016-01-01

The continuing professional development (CPD) of teachers has increasingly come to be considered an important component of teacher policy reforms throughout much of the world. As part of its comprehensive school improvement and teacher development programmes, Ethiopia has recently developed a national policy framework on CPD for teachers. Arguing…

Extending Theorisations of the Global Teacher: Care Work, Gender, and Street-Level Policies

ERIC Educational Resources Information Center

Robert, Sarah A.

2016-01-01

This article is concerned with teachers' negotiation of global transitions premised on improving educational opportunity with implications for professionalism. The study blends sociology of gender, work, and organisations and gender policy analysis to theorise teachers' policy negotiations. I explore how 20 Argentine teachers mediate 3 programmes'…

Steering the National: Exploring the Education Policy Uses of PISA in Spain

ERIC Educational Resources Information Center

Engel, Laura C.

2015-01-01

This article presents findings from a recent study of the education policy uses and impact of international large-scale assessments, namely the Programme for International Student Assessment (PISA). The paper focuses on two overlapping dimensions of PISA's education policy use in the context of Spain. These include political dimensions, such as…

Creative Partnerships? Cultural Policy and Inclusive Arts Practice in One Primary School

ERIC Educational Resources Information Center

Hall, Christine; Thomson, Pat

2007-01-01

This article traces the "cultural turn" in UK educational policy through an analysis of the Creative Partnerships policy (New Labour's "flagship programme in the cultural education field") and a consideration of an arts project funded under this initiative in one primary school. It argues that current educational policy…

Safety in Outdoor Adventure Programs. S.O.A.P. Safety Policy.

ERIC Educational Resources Information Center

MacDonald, Wayne, Comp.; And Others

Drafted in 1978 as a working document for Safety in Outdoor Adventure Programs (S.O.A.P.) by a council of outdoor adventure programmers, checklists outline standard accepted safety policy for Outdoor Adventure Programs and Wilderness Adventure Programs conducted through public or private agencies in California. Safety policy emphasizes: the…

Commissioning the University of Excellence: Swedish Research Policy and New Public Research Funding Programmes

ERIC Educational Resources Information Center

Hallonsten, Olof; Silander, Charlotte

2012-01-01

In many countries, current research policy is dominated by managerialism and excellence, manifesting the aim of making universities into national strategic assets in the globally competitive knowledge economy. This article discusses these policy trends and their mirror in recent developments in public funding for academic research, with special…

Patterns in National Policies for Support of Low Achievers in Reading across Europe

ERIC Educational Resources Information Center

Motiejunaite, Akvile; Noorani, Sogol; Monseur, Christian

2014-01-01

This paper brings together data on national policies for improving reading achievement with student reading outcomes according to the OECD Programme for International Student Assessment (PISA) 2009 data. It is based on a two-step analysis. Firstly, the prevalence of national policies for improving reading achievement (i.e., specialist reading…

Hobson's Choice: Education Policies in the 2010 General Election

ERIC Educational Resources Information Center

Gillard, Derek

2010-01-01

This article summarises the policies relating to families, children and education which were presented to the electorate by the three main parties in their manifestos, together with the policies listed in the Coalition's "Programme for Government". The author concludes with a few observations on the future of state education in England.

The role of parliamentarians in promoting sexual and reproductive health and rights.

PubMed

McCafferty, Christine

2009-08-01

Parliamentarians are central to the full implementation of the International Conference on Population and Development Programme of Action (ICPD PoA). We promote, review, and adopt sexual and reproductive health and rights (SRHR) legislation, including budget appropriations. Parliamentarians also approve policies formulated by government and endorse resolutions and statements in support of SRHR. All Party Parliamentary Groups on Population, Development, and Reproductive Health have now been established in nearly 100 countries to promote the ICPD PoA. Examples are given of successful SRHR parliamentary advocacy in the UK, Europe, and internationally. The biggest constraint to achieving universal access to reproductive health services by 2015 (the new MDG 5 target) remains ideological-driven campaigns across Europe and the USA. Politicians must be brave and speak out against misinformation or ill-informed and ideological-driven campaigns that mitigate the promotion of women's SRHR.

Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: long-term follow-up including comparisons with a matched population-based reference cohort.

PubMed

Währborg, Peter; Petersson, Ingemar F; Grahn, Patrik

2014-03-01

To determine the effect of a nature-assisted rehabilitation programme in a group of patients with reactions to severe stress and/or mild to moderate depression. Changes in sick-leave status and healthcare consumption in these patients were compared with those in a matched population-based reference cohort (treatment as usual). Retrospective cohort study with a matched reference group from the general population. A total of 118 participants referred to a nature-assisted rehabilitation programme, and 678 controls recruited from the Skåne Health Care Register. For both groups, information on sick leave was extracted from the National Social Insurance Register and on healthcare consumption data from the Skåne Health Care Register. The interventional rehabilitation programme was designed as a multimodal programme involving professionals from horticulture and medicine. The programme was conducted in a rehabilitation garden, designed especially for this purpose. A significant reduction in healthcare consumption was noted among participants in the programme compared with the reference population. The main changes were a reduction in outpatient visits to primary healthcare and a reduction in inpatient psychiatric care. No significant difference in sick-leave status was found. A structured, nature-based rehabilitation programme for patients with reactions to severe stress and/or depression could be beneficial, as reflected in reduced healthcare consumption.

School food research: building the evidence base for policy.

PubMed

Nelson, Michael; Breda, João

2013-06-01

Following an international workshop on developing the evidence base for policy relating to school food held in London, UK, in January 2012, the objectives of the present paper were (i) to outline a rationale for school food research, monitoring and evaluation in relation to policy and (ii) to identify ways forward for future working. The authors analysed presentations, summaries of evidence, and notes from discussions held at the international workshop in London in 2012 to distil common themes and make recommendations for the development of coherent research programmes relating to food and nutrition in schools. International, with an emphasis on middle- and high-income countries. Overviews of existing school food and nutrition programmes from the UK, Hungary, Sweden, the USA, Australia, Brazil, China, Mexico and other countries were presented, along with information on monitoring, evaluation and other research to demonstrate the impact of school feeding on health, attainment, food sourcing, procurement and finances, in the context of interactions between the evidence base and policy decisions. This provided the material which, together with summaries and notes of discussions, was used to develop recommendations for the development and dissemination of robust approaches to sustainable and effective school food and nutrition programmes in middle- and high-income countries, including policy guidelines, standards, cost-effectiveness measures and the terms of political engagement. School food and nutrition can provide a cohesive core for health, education and agricultural improvement provided: (i) policy is appropriately framed and includes robust monitoring and evaluation; and (ii) all stakeholders are adequately engaged in the process. International exchange of information will be used to develop a comprehensive guide to the assessment of the impact of school food and nutrition policy and supporting infrastructure.

Policy challenges facing integrated community case management in Sub-Saharan Africa.

PubMed

Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah; Juma, Pamela; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda; Cliff, Julie

2014-07-01

To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Policy challenges facing integrated community case management in Sub-Saharan Africa

PubMed Central

Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah; Juma, Pamela; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda; Cliff, Julie

2014-01-01

Objective To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Methods Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. Results Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. Conclusions iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. PMID:24750516

"Making it personal": ideology, the arts, and shifting registers in health promotion.

PubMed

Ruthven, Jessica S

2016-01-01

In South Africa, health promotion related to HIV/AIDS has been characterised as a component of public health prevention. It has heavily utilised global health ideology to construct promotional messages that rely on neoliberal models of individual, responsible health citizenship. However, after nearly 30 years of public health messaging, there have been only minor shifts in the country's HIV prevalence rates; it has become apparent that there is disconnect between policy, programmes, and target audiences. Debates about where this disconnect occurs tend to focus on the role of problems in biomedical knowledge translation or with structural inequalities that lead to health inequity. As debates increase, artists involved in health have emerged to address an additional reason: audience interpellation. In this article, I interrogate relationships between health promotion ideology and processes of interpellation. I suggest that disconnect between the two has roots in the tone of programming, the ways sociality is constructed within health promotion, and the kind of subject which global prevention programmes seek to constitute. Using a case study, I illustrate how public health ideology is made actionable through arts practice. While conventional health promotion programmes address populations in a way that allows individuals to distance themselves, members of South Africa's arts sector have worked to integrate prevention and care in a way that bolsters interpellation through making messages personal. The case study presents one performance but is informed by my broader research with over 20 theatrical groups conducted during 18 months of fieldwork. Analysis of the production reveals that artists act as mediators between population-level public health messages and individuals through the embodied technologies of applied theatre. However, I argue that artists also create space for participants to reimagine configurations of care, responsibility, and intimacy within health practices.

Participants’ perceptions of a knowledge-brokering strategy to facilitate evidence-informed policy-making in Fiji

PubMed Central

2013-01-01

Background Evidence-informed policy-making (EIPM) is optimal when evidence-producers (researchers) and policy developers work collaboratively to ensure the production and use of the best available evidence. This paper examined participants’ perceptions of knowledge-brokering strategies used in the TROPIC (Translational Research in Obesity Prevention in Communities) project to facilitate the use of obesity-related evidence in policy development in Fiji. Method Knowledge-brokers delivered a 12-18 month programme comprising workshops targeting EIPM skills and practical support for developing evidence-informed policy briefs to reduce obesity. The programme was tailored to each of the six participating organizations. Knowledge-brokering strategies included negotiating topics that were aligned to the goals of individual organizations, monitoring and evaluating time-management skills, accommodating other organizational and individual priorities, delivering practical sessions on use of appropriate research tools and supporting individual writing of policy briefs. Two qualitative methods were used to examine individuals’ perceptions of skills obtained, opportunities afforded by the TROPIC project, facilitators and inhibiters to planned policy brief development and suggestions for improved programme delivery. Forty-nine participants completed an electronic word table and then participated in a semi-structured interview. An independent interviewer conducted structured interviews with a high-ranking officer in each organization to examine their perceptions of TROPIC engagement strategies. Data were analyzed descriptively and thematically, with the first author and another experienced qualitative researcher analyzing data sets separately, and then combining analyses. Results Many participants believed that they had increased their skills in acquiring, assessing, adapting and applying evidence, writing policy briefs and presenting evidence-based arguments to higher levels. Many participants preferred one-to-one meetings to group activities to ensure early resolution of developing issues and to refine policy briefs. Perceived barriers to EIPM were lack of knowledge about data sources, inadequate time to develop evidence-informed briefs, and insufficient resources for accessing and managing evidence. Conclusion An innovative knowledge-brokering approach utilizing skill development and mentorship facilitated individual EIPM skills and policy brief development. The TROPIC model could stimulate evidence-based policy action relating to obesity prevention and other policy areas in other Pacific countries and elsewhere. PMID:23919672

Development of a framework to improve the utilisation of malaria research for policy development in Malawi.

PubMed

Mwendera, Chikondi; de Jager, Christiaan; Longwe, Herbert; Hongoro, Charles; Phiri, Kamija; Mutero, Clifford M

2017-11-21

The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhance knowledge translation. These efforts aim at maximising health research utilisation in policy and practice to address the world's disease burdens, including malaria. This study aimed at developing a contextual framework to improve the utilisation of malaria research for policy development in Malawi. The study used two approaches including: two case studies of policy analysis exploring the policy-making process in Malawi, utilisation of local malaria research, and the role of key stakeholders in policy formulation process; and the assessment of facilitating factors and barriers to malaria research utilisation for policy-making in Malawi. From the case studies' lessons and elements identified during the assessment of facilitating factors and barriers, a framework is developed to promote an integrated approach to knowledge translation. In this framework the Ministry of Health is considered as the main user of knowledge from research through the demand created by the research directorate and the National Malaria Control Programme. Key documents identified as being particularly relevant to the Ministry of Health for purposes of knowledge translation include the National Health Research Agenda, Guidelines for Policy Development and Analysis, and Guidelines for Evidence Use in Policy-making. Institutions conducting academic and policy-relevant malaria research in Malawi are identified and a consolidation of their linkages with the users of research is established through the Knowledge Translation Unit, the Evidence Informed decision-making Centre, and the African Institute for Development Policy. Equally, key players in this framework are the funding partners for both research and programmes that need to see accountability and impact of their support. Independent advisors, partners, and consultants also have their vital role in the process. The framework offers a practical basis for the factors identified and their linkages to promote a co-ordinated approach to malaria research utilisation in policy-making. Its applicability and success hinges on its wider dissemination and ownership by the government through the National Malaria Control Programme.

A rapid review of key strategies to improve the cognitive and social development of children in Scotland.

PubMed

Geddes, Rosemary; Frank, John; Haw, Sally

2011-06-01

Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland. A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland. : Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems. Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Withdrawing low risk women from cervical screening programmes: mathematical modelling study

PubMed Central

Sherlaw-Johnson, C; Gallivan, S; Jenkins, D

1999-01-01

Objective To evaluate the impact of policies for removing women before the recommended age of 64 from screening programmes for cervical cancer in the United Kingdom. Design A mathematical model of the clinical course of precancerous lesions which accounts for the influence of infection with the human papillomavirus, the effects of screening on the progression of disease, and the accuracy of the testing procedures. Two policies are compared: one in which women are withdrawn from the programme if their current smear is negative and they have a recent history of regular, negative results and one in which women are withdrawn if their current smear test is negative and a simultaneous test is negative for exposure to high risk types of human papillomavirus. Setting United Kingdom cervical screening programme. Main outcome measures The incidence of invasive cervical cancer and the use of resources. Results Early withdrawal of selected women from the programme is predicted to give rise to resource savings of up to 25% for smear tests and 18% for colposcopies when withdrawal occurs from age 50, the youngest age considered in the study. An increase in the incidence of invasive cervical cancer, by up to 2 cases/100 000 women each year is predicted. Testing for human papillomavirus infection to determine which women should be withdrawn from the programme makes little difference to outcome. Conclusions This model systematically analyses the consequences of screening options using available data and the clinical course of precancerous lesions. If further audit studies confirm the model’s forecasts, a policy of early withdrawal might be considered. This would be likely to release substantial resources which could be channelled into other aspects of health care or may be more effectively used within the cervical screening programme to counteract the possible increase in cancer incidence that early withdrawal might bring. Key messagesIn the United Kingdom there is concern that the cervical screening programme uses a large amount of resources to screen postmenopausal women who are at low risk of cervical cancerThere may be advantages to withdrawing these women from the screening programme before they reach the recommended age of 64A mathematical modelling approach can be used to evaluate the effectiveness of different policies for early withdrawal from screening with or without an additional test for human papillomavirus DNAEarly withdrawal could lead to a substantial reduction in the resources devoted to screening which could be channelled more effectively into other aspects of health careEarly withdrawal is likely to increase the overall incidence of cervical cancer unless other steps are taken to compensate PMID:9933195

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

PubMed

Moosa, Shabir; Derese, Anselme; Peersman, Wim

2017-01-21

Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues.

Costs analysis of a population level rabies control programme in Tamil Nadu, India.

PubMed

Abbas, Syed Shahid; Kakkar, Manish; Rogawski, Elizabeth Tacket

2014-02-01

The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. This built upon an earlier assessment of Tamil Nadu's efforts to control rabies. Anti-rabies vaccines were made available at all health facilities. Costs were estimated for five different combinations of animal and human interventions using an activity-based costing approach from the provider perspective. Disease and population data were sourced from the state surveillance data, human census and livestock census. Program costs were extrapolated from official documents. All capital costs were depreciated to estimate annualized costs. All costs were inflated to 2012 Rupees. Sensitivity analysis was conducted across all major cost centres to assess their relative impact on program costs. It was found that the annual costs of providing Anti-rabies vaccine alone and in combination with Immunoglobulins was $0.7 million (Rs 36 million) and $2.2 million (Rs 119 million), respectively. For animal sector interventions, the annualised costs of rolling out surgical sterilisation-immunization, injectable immunization and oral immunizations were estimated to be $ 44 million (Rs 2,350 million), $23 million (Rs 1,230 million) and $ 11 million (Rs 590 million), respectively. Dog bite incidence, health systems coverage and cost of rabies biologicals were found to be important drivers of costs for human interventions. For the animal sector interventions, the size of dog catching team, dog population and vaccine costs were found to be driving the costs. Rabies control in Tamil Nadu seems a costly proposition the way it is currently structured. Policy makers in Tamil Nadu and other similar settings should consider the long-term financial sustainability before embarking upon a state or nation-wide rabies control programme.

Costs Analysis of a Population Level Rabies Control Programme in Tamil Nadu, India

PubMed Central

Abbas, Syed Shahid; Kakkar, Manish; Rogawski, Elizabeth Tacket

2014-01-01

The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. This built upon an earlier assessment of Tamil Nadu's efforts to control rabies. Anti-rabies vaccines were made available at all health facilities. Costs were estimated for five different combinations of animal and human interventions using an activity-based costing approach from the provider perspective. Disease and population data were sourced from the state surveillance data, human census and livestock census. Program costs were extrapolated from official documents. All capital costs were depreciated to estimate annualized costs. All costs were inflated to 2012 Rupees. Sensitivity analysis was conducted across all major cost centres to assess their relative impact on program costs. It was found that the annual costs of providing Anti-rabies vaccine alone and in combination with Immunoglobulins was $0.7 million (Rs 36 million) and $2.2 million (Rs 119 million), respectively. For animal sector interventions, the annualised costs of rolling out surgical sterilisation-immunization, injectable immunization and oral immunizations were estimated to be $ 44 million (Rs 2,350 million), $23 million (Rs 1,230 million) and $ 11 million (Rs 590 million), respectively. Dog bite incidence, health systems coverage and cost of rabies biologicals were found to be important drivers of costs for human interventions. For the animal sector interventions, the size of dog catching team, dog population and vaccine costs were found to be driving the costs. Rabies control in Tamil Nadu seems a costly proposition the way it is currently structured. Policy makers in Tamil Nadu and other similar settings should consider the long-term financial sustainability before embarking upon a state or nation-wide rabies control programme. PMID:24587471

Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives.

PubMed

Pongcharoensuk, Petcharat; Adisasmito, Wiku; Sat, Le Minh; Silkavute, Pornpit; Muchlisoh, Lilis; Cong Hoat, Pham; Coker, Richard

2012-08-01

The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes. The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand's poultry industry is large and principally an export economy, Vietnam's and Indonesia's are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy. With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.

Simulation of Population Processes with a Programmable Pocket Calculator.

ERIC Educational Resources Information Center

Kidd, N. A. C.

1979-01-01

Presents a set of simulation models for use in teaching population dynamics. These models are designed specifically for use with a programmable pocket calculator, and can be used to demonstrate growth of populations with discrete or overlapping generations and also to explore effects of density-dependent and -independent mortality. (Author/CS)

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.

PubMed

McVeigh, Joanne; MacLachlan, Malcolm; Gilmore, Brynne; McClean, Chiedza; Eide, Arne H; Mannan, Hasheem; Geiser, Priscille; Duttine, Antony; Mji, Gubela; McAuliffe, Eilish; Sprunt, Beth; Amin, Mutamad; Normand, Charles

2016-08-24

Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation. An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.

Measuring informed choice in population-based reproductive genetic screening: a systematic review

PubMed Central

Ames, Alice Grace; Metcalfe, Sylvia Ann; Archibald, Alison Dalton; Duncan, Rony Emily; Emery, Jon

2015-01-01

Genetic screening and health-care guidelines recommend that programmes should facilitate informed choice. It is therefore important that accurate measures of informed choice are available to evaluate such programmes. This review synthesises and appraises measures used to evaluate informed choice in population-based genetic screening programmes for reproductive risk. Databases were searched for studies offering genetic screening for the purpose of establishing reproductive risk to an adult population sample, in which aspects of informed choice were measured. Studies were included if, at a minimum, measures of uptake of screening and knowledge were used. Searches identified 1462 citations and 76 studies were reviewed in full text; 34 studies met the inclusion criteria. Over 20 different measures of informed choice were used. Many measures lacked adequate validity and reliability data. This systematic review will inform future evaluation of informed choice in population genetic screening programmes. PMID:24848746

Gender equity programmes in academic medicine: a realist evaluation approach to Athena SWAN processes

PubMed Central

Caffrey, Louise; Mattingley, Helena; Williamson, Catherine; McKevitt, Christopher

2016-01-01

Objectives Gender inequity has persisted in academic medicine. Yet equity is vital for countries to achieve their full potential in terms of translational research and patient benefit. This study sought to understand how the gender equity programme, Athena SWAN, can be enabled and constrained by interactions between the programme and the context it is implemented into, and whether these interactions might produce unintended consequences. Design Multimethod qualitative case studies using a realist evaluation approach. Setting 5 departments from a university medical school hosting a Translational Research Organisation. Participants 25 hours of observations of gender equality committee meetings, 16 in-depth interviews with Heads of Departments, Committee Leads and key personnel involved in the initiative. 4 focus groups with 15 postdoctoral researchers, lecturers and senior lecturers. Results The implementation of Athena SWAN principles was reported to have created social space to address gender inequity and to have highlighted problematic practices to staff. However, a number of factors reduced the programme's potential to impact gender inequity. Gender inequity was reproduced in the programme's enactment as female staff was undertaking a disproportionate amount of Athena SWAN work, with potential negative impacts on individual women's career progression. Early career researchers experienced problems accessing Athena SWAN initiatives. Furthermore, the impact of the programme was perceived to be undermined by wider institutional practices, national policies and societal norms, which are beyond the programme's remit. Conclusions Gender equity programmes have the potential to address inequity. However, paradoxically, they can also unintentionally reproduce and reinforce gender inequity through their enactment. Potential programme impacts may be undermined by barriers to staff availing of career development and training initiatives, and by wider institutional practices, national policies and societal norms. PMID:27609850

WHO policy development processes for a new vaccine: case study of malaria vaccines.

PubMed

Milstien, Julie; Cárdenas, Vicky; Cheyne, James; Brooks, Alan

2010-06-24

Recommendations from the World Health Organization (WHO) are crucial to inform developing country decisions to use, or not, a new intervention. This article analysed the WHO policy development process to predict its course for a malaria vaccine. The decision-making processes for one malaria intervention and four vaccines were classified through (1) consultations with staff and expert advisors to WHO's Global Malaria Programme (GMP) and Immunization, Vaccines and Biologicals Department (IVB); (2) analysis of the procedures and recommendations of the major policy-making bodies of these groups; (3) interviews with staff of partnerships working toward new vaccine availability; and (4) review and analyses of evidence informing key policy decisions. WHO policy formulation related to use of intermittent preventive treatment in infancy (IPTi) and the following vaccine interventions: Haemophilus influenzae type b conjugate vaccine (Hib), pneumococcal conjugate vaccine (PCV), rotavirus vaccine (RV), and human papillomavirus vaccine (HPV), five interventions which had relatively recently been through systematic WHO policy development processes as currently constituted, was analysed. Required information was categorized in three areas defined by a recent WHO publication on development of guidelines: safety and efficacy in relevant populations, implications for costs and population health, and localization of data to specific epidemiological situations. Data needs for a malaria vaccine include safety; the demonstration of efficacy in a range of epidemiological settings in the context of other malaria prevention interventions; and information on potential rebound in which disease increases subsequent to the intervention. In addition, a malaria vaccine would require attention to additional factors, such as costs and cost-effectiveness, supply and demand, impact of use on other interventions, and distribution issues. Although policy issues may be more complex for future vaccines, the lead-time between the date of product regulatory approval and a recommendation for its use in developing countries is decreasing. This study presents approaches to define in advance core data needs to support evidence-based decisions, to further decrease this lead-time, accelerating the availability of a malaria vaccine. Specific policy areas for which information should be collected are defined, including studying its use within the context of other malaria interventions.

Setting the Context for Using Complexity Theory in Evaluation: Boundaries, Governance and Utilisation

ERIC Educational Resources Information Center

Walton, Mat

2016-01-01

Recent literature has usefully explored the application of complexity theory to evaluation. However, there is little discussion of the contextual conditions in applying complexity theory. Drawing upon a single complexity-consistent public health programme evaluation and subsequent policy decisions, this paper considers how programme framing and…

Crossing the Chasm--Introducing Flexible Learning into the Botswana Technical Education Programme: From Policy to Action

ERIC Educational Resources Information Center

Richardson, Alison Mead

2009-01-01

This paper reports on a longitudinal, ethnomethodological case study of the development towards flexible delivery of the Botswana Technical Education Programme (BTEP), offered by Francistown College of Technical & Vocational Education (FCTVE). Data collection methods included documentary analysis, naturalistic participant observation, and…

The Radical Challenge of Family Learning

ERIC Educational Resources Information Center

West, Linden

2005-01-01

This article focuses on the nature of "family learning" programmes in marginalised communities. Such programmes present a series of radical challenges (in the sense of getting to the root of things) to policy makers and professionals alike: about, for instance, the kinds of "learning" on offer and the neglect, perhaps…

An appraisal of policies and institutional frameworks impacting on smallholder agricultural water management in Zimbabwe

NASA Astrophysics Data System (ADS)

Nyagumbo, I.; Rurinda, J.

Policies and institutional frameworks associated with and / or impacting on agricultural water management (AWM) in smallholder farming systems in Zimbabwe were analyzed through literature reviews, feedback from stakeholder workshops, key informant interviews and evaluation of policy impacts on implemented case study projects/programmes. The study showed that Zimbabwe has gone a long way towards developing a water management policy addressing both equity and access, through the Water and ZINWA of 1998. However, lack of incentives for improving efficient management and utilization of water resources once water has reached the farm gate was apparent, apart from punitive economic instruments levied on usage of increased volumes of water. For example, the new water reforms of 1998 penalized water savers through loss of any unused water in their permits to other users. In addition, the ability of smallholder farmers to access water for irrigation or other purposes was influenced by macro and micro-economic policies such as Economic Structural and Adjustment Programme (ESAP), Zimbabwe Programme for Economic and Social Transformation (ZIMPREST), prevailing monetary and fiscal policies, as well as the Land and Agrarian Reform policies. For instance, the implementation of ESAP from 1991 to 95 resulted in a decline in government support to management of communal irrigation schemes, and as a result only gravity-fed schemes survived. Also AWM projects/programmes that were in progress were prematurely terminated. While considerable emphasis was placed on rehabilitation of irrigation infrastructure since the fast track land reform in 1998, the policies remained rather silent on strategies for water management in rainfed systems. The piecemeal nature and fragmentation of policies and institutional frameworks scattered across government ministries and sectors were complex and created difficulties for smallholder farmers to access water resources. Poor policy implementation strategies and lack of funding were some of the major weaknesses in Zimbabwe’s AWM policies. It was apparent that the prevailing institutional frameworks that underwent restructuring exercises since 2000, failed to effectively deliver services to smallholder farmers due to lack of human and financial capital. Nevertheless, the study showed that policies that can improve efficient utilization of agricultural water in rainfed systems need to target timely provision of the prime movers, i.e. credit, input markets and viable output markets, among other factors, so as to fully utilize good rainfall seasons. It was recommended that a forum led by ZINWA be set up to harmonize AWM issues across sectors and monitor their implementation. Such a forum would be mandated mainly to run periodic water management workshops in which relevant and interested stakeholders participate. ZINWA stands for Zimbabwe National Water Authority.

Weak surveillance and policy attention to cancer in global health: the example of Mozambique

PubMed Central

Carrilho, Carla; Ismail, Mamudo R; Castillo, Paola; Augusto, Orvalho; Sidat, Mohsin; Menéndez, Clara; Garcia-Basteiro, Alberto L; Ordi, Jaume

2018-01-01

Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention. PMID:29607101

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

PubMed

Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

2007-10-06

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

Assisted reproduction in Indonesia: policy reform in an Islamic culture and developing nation.

PubMed

Purvis, Taylor E

2015-11-01

This article considers how religious and economic factors shape assisted reproductive technology (ART) policy in Indonesia, the world's most populous Muslim country. Infertility clinic policies are grounded on both the views of the country's powerful Islamic coalition and those of the worldwide Islamic community. Indonesian government officials, physicians, and Islamic scholars have expressed concern over who can use ART and which procedures can be performed. Indonesia has also faced economic challenges related to ART, including inadequate health insurance coverage, inequitable access to ART, and maintenance of expensive ART infrastructure. The prohibitive price of infertility treatment and regional differences in the provision of health care prohibit most Indonesians from obtaining ART. In the absence of a shift in religious mores and a rapid reduction in poverty and inequality, Indonesia will need to adopt creative means to make ART both more available and less necessary as a solution to infertility. This paper suggests policy reforms to promote more affordable treatment methods and support preventative health programmes to reduce infertility rates. This country-specific analysis of the laws and customs surrounding ART in Indonesia reveals that strategies to reduce infertility must be tailored to a country's unique religious and economic climate. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

The challenge and impact of engaging hard-to-reach populations in regular physical activity and health behaviours: an examination of an English Premier League 'Football in the Community' men's health programme.

PubMed

Curran, K; Drust, B; Murphy, R; Pringle, A; Richardson, D

2016-06-01

To investigate the challenges that men from hard-to-reach (HTR) populations encounter when attempting to commit to regular participation in physical activity and health behaviours, and to explore the psychological and social effects of participation in a twelve week football-led health improvement intervention. A twelve week football specific physical activity intervention targeting men from HTR populations was delivered by Everton Football Clubs' Football in the Community (FitC) scheme as part of a national programme of men's health delivered in/by English Premier League (EPL) football clubs. Men living in homeless shelters and/or recovering from substance misuse were recruited over a period of three months. The programme consisted of a two hour football session, twice weekly, alongside the dissemination of healthy living messages. Football sessions were conducted by a qualified FitC coach. This research was conducted during a twelve week period of immersed practitioner-research. Ethnographic and observational methodologies were adopted. Psychosocial issues were discussed with participants through informal client-researcher interactions and data were logged via field notes. Records of attendance were logged. Participants who failed to attend a session were contacted and their reason(s) for non-attendance were recorded. Data were analysed using deductive and inductive reasoning. Despite the apparent ambition of the participants to regularly participate in the FitC programme, adherence to the programme was poor. Economic, environmental and social barriers to engagement in the programme were apparent. Engagement in the programme resulted in positive psychosocial developments; the development of structure, social interaction and social capital. Community based football-led health improvement programmes endorsed by professional football clubs appear well positioned to connect with, and attract, men from HTR populations. The evidence suggests that such programmes can improve psychosocial health amongst these populations. However, a bottom-up programme design and management strategy is required in order to reduce the challenges facing HTR participants when attempting to regularly engage in physical activity and health behaviours. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Reduced Genetic Diversity and Increased Structure in American Mink on the Swedish Coast following Invasive Species Control.

PubMed

Zalewski, Andrzej; Zalewska, Hanna; Lunneryd, Sven-Gunnar; André, Carl; Mikusiński, Grzegorz

2016-01-01

Eradication and population reductions are often used to mitigate the negative impacts of non-native invasive species on native biodiversity. However, monitoring the effectiveness of non-native species control programmes is necessary to evaluate the efficacy of these measures. Genetic monitoring could provide valuable insights into temporal changes in demographic, ecological, and evolutionary processes in invasive populations being subject to control programmes. Such programmes should cause a decrease in effective population size and/or in genetic diversity of the targeted non-native species and an increase in population genetic structuring over time. We used microsatellite DNA data from American mink (Neovison vison) to determine whether the removal of this predator on the Koster Islands archipelago and the nearby Swedish mainland affected genetic variation over six consecutive years of mink culling by trappers as part of a population control programme. We found that on Koster Islands allelic richness decreased (from on average 4.53 to 3.55), genetic structuring increased, and effective population size did not change. In contrast, the mink population from the Swedish coast showed no changes in genetic diversity or structure, suggesting the stability of this population over 6 years of culling. Effective population size did not change over time but was higher on the coast than on the islands across all years. Migration rates from the islands to the coast were almost two times higher than from the coast to the islands. Most migrants leaving the coast were localised on the southern edge of the archipelago, as expected from the direction of the sea current between the two sites. Genetic monitoring provided valuable information on temporal changes in the population of American mink suggesting that this approach can be used to evaluate and improve control programmes of invasive vertebrates.

Quality evaluation in the management of child sponsorship programmes.

PubMed

McDonnell, W A; McDonnell, T P

1994-08-01

Programme evaluation tactics for child sponsorship programmes have historically concentrated on quantitative analysis of service units, amount of money invested, number of countries served, the number of projects, and number of children in each project. While these are valuable measures of programme variables, they do not assess the impact of programmes on the lives of the children sponsored. Outcome measures designed to assess programme impact add greatly to the information available to child welfare professionals. This study collected data about the impact of the programme on the lives of the children. The Child Welfare League's Child Well-Being Scales (CWBS) were used to assess programme impact. Twelve scales were chosen as directly related in type to the programmes administered by Children International, a traditional and well established child sponsorship organization located in Kansas City, Missouri. A thirteenth scale was suggested by field workers in India as particularly relevant to Third World populations. The scales were translated into languages appropriate to each population in the programme countries. Social workers in each country were trained to administer and score them. This analysis used the emerging data technology becoming available to programmes in Third World countries. The system enables administrators in the Third World to evaluate, enhance and summarize their programmes in a way understandable across borders. Epi Info (Dean et al., 1990) was customized to provide the framework for the analysis. The population for this study was selected by a 5% random sampling of children currently enrolled as sponsored children (180,000+ worldwide). These were compared with a waiting-list control group selected randomly from lists of children who have applied for sponsorship but have not yet been receiving services (n = 50 from each project).(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes.

PubMed

Tkatchenko-Schmidt, Elena; Renton, Adrian; Gevorgyan, Ruzanna; Davydenko, Ludmila; Atun, Rifat

2008-02-01

to examine attitudes of Russian policy-makers and HIV stakeholders towards harm reduction (HR) scale up, focusing on the factors constraining the scale-up process. Semi-structured interviews with representatives of 58 government and non-governmental organisations involved in HIV policies and programmes in Volgograd Region, Russian Federation. We found a considerable diversity of opinion on HR scale-up and suggest that Russia is experiencing the situation of power parity between HR supporters and opponents with many stakeholders being indecisive or cautious to express their views. We identified six main factors which constrain policy decisions in favour of HR scale-up: insufficient financial resources; lack of information on HR effectiveness; perception of HR as being culturally unacceptable; reluctance of IDUs to use the services; opposition from law enforcement agencies and the Russian Church; and unclear legal regulations. We demonstrate a complex interplay between these factors, policy-makers' attitudes and their choices on HR scale-up. A number of actions are needed to achieve a successful scale-up of HR programmes in Russia and similar political contexts: (i) a strategic approach to HR advocacy, targeting neutral and indecisive stakeholders; (ii) more systematic evidence on HR effectiveness and cost-effectiveness in the local context; (iii) HR advocacy targeting law enforcement agencies and the Russian Church; and (iv) aligning best international HR practices with the objectives of local policy-makers, practitioners and service-users.

Having the rug pulled from under your feet: one project's experience of the US policy reversal on sex work.

PubMed

Busza, Joanna

2006-07-01

After the election of President George W Bush in 2000, US government policy toward sexual and reproductive health changed dramatically. In May 2003, the Global AIDS Act was passed and prohibits allocation of US government funds to organizations that 'promote or advocate' legalization and practice of prostitution and sex trafficking. There are few documented examples of early impacts of this policy reversal on USAID-funded programmes already working with sex worker communities. This paper offers an anecdotal account of one programme in Cambodia that found itself caught in the ideological cross-fire of US politics, and describes consequent negative effects on the project's ability to offer appropriate and effective HIV prevention services to vulnerable migrant sex workers.

Active Social Policy Meets the Discipline of the Australian Marketplace: The Outcomes of Mobile Policies

ERIC Educational Resources Information Center

Zoellner, Don

2016-01-01

Many advanced market democracies pursue social justice by bundling together a range of programmes represented as active social policy. Northern European exemplars sanction employment as an economic and social citizen's civic obligation, promote lifelong learning and place welfare payments as a last resort. In the United States, market-based…

Reflections on the Implementation of the Gifted and Talented Policy in England, 1999-2011

ERIC Educational Resources Information Center

Brady, Maggie; Koshy, Valsa

2014-01-01

The landscape of gifted and talented education in England has changed in the past decade when the UK government launched an education programme for "gifted and talented" pupils as part of its Excellence in Cities policy initiative. The policy was initially intended to raise educational achievement of higher ability pupils in secondary…

Governance for Learning Outcomes in European Policy-Making: Qualification Frameworks Pushed through the Open Method of Coordination

ERIC Educational Resources Information Center

Ure, Odd Bjørn

2015-01-01

The construction of European education policy builds on a widely shared goal of transparency in qualifications, upheld by the popular narrative of mobile students endowed with scholarships from the EU Erasmus programme, which allow them to transfer credit points between universities and across national borders. EU education policy is increasingly…

Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America

PubMed Central

Ravasi, Giovanni; Grinsztejn, Beatriz; Baruch, Ricardo; Guanira, Juan Vicente; Luque, Ricardo; Cáceres, Carlos F; Ghidinelli, Massimo

2016-01-01

Introduction Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. Discussion Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. Conclusions PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes. PMID:27760687

Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America.

PubMed

Ravasi, Giovanni; Grinsztejn, Beatriz; Baruch, Ricardo; Guanira, Juan Vicente; Luque, Ricardo; Cáceres, Carlos F; Ghidinelli, Massimo

2016-01-01

Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes.

An assessment of oral health promotion programmes in the United Kingdom.

PubMed

Passalacqua, A; Reeves, A O; Newton, T; Hughes, R; Dunne, S; Donaldson, N; Wilson, N

2012-02-01

Improving oral health and reducing tooth decay is a key area for action, both in the United Kingdom (UK) and overseas. The World Health Organization (WHO) has highlighted the unique advantage schools have in promoting oral health. We summarise current oral health promotion strategies in the United Kingdom and estimate the spread of their use as well as their impact on oral health and influence on the oral health-related knowledge and behaviour in a patient population. A structured overview of published papers, government publications, official government websites and policy reports. A cross-sectional study of patients referred for a tooth extraction in one dental surgery in south-east London. Statistical methods consisted of logistic and ordinal regressions to model the likelihood of exposure to oral health promotion and of obtaining higher levels of knowledge of oral health issues, respectively. Linear regression was used to model the level of oral health and knowledge of oral health issues. We found three main promotion programmes, namely, National Healthy Schools (NHS), Sure Start and Brushing for life plus a small number of local initiatives. Sure Start targets disadvantaged areas, but is limited. In our observational study, 34% of the patients reported exposure to a settings-based oral health education programme: Sure Start (5%), NHS (7%) and other (22%). This exposure was not influenced by age or gender, but an association with education was detected. Although oral health promotion was not found to influence the actual knowledge of oral health issues, it was found to influence some oral health-related attitudes and perceptions. Participation in an oral health promotion programme was found to be significantly associated with the patients' education, their belief that they can prevent oral disease and the subjective perception of their own oral health. The WHO principles need to be embedded across all schools to achieve a true national oral health promotion programme for the United Kingdom. The National Healthy Schools programme provides the perfect platform. © 2011 John Wiley & Sons A/S.

Setting the stage for school health-promoting programmes for deaf children in Spain.

PubMed

Munoz-Baell, Irma M; Alvarez-Dardet, Carlos; Ruiz, M Teresa; Ferreiro-Lago, Emilio; Aroca-Fernandez, Eva

2008-12-01

Implementing health-promoting programmes for the most excluded and at-risk social groups forms a key part of any efforts to address underserved populations and reduce health inequalities in society. However, many at-risk children, particularly children in deaf communities, are not reached, or are poorly served, by health-promoting programmes within the school setting. This is so because schools are effective as health-promoting environments for d/Deaf children only to the extent that they properly address their unique communication needs and ensure they are both able and enabled to learn in a communication-rich and supportive psycho-social environment. This article examines how the usually separate strands of school health promotion and d/Deaf education might be woven together and illustrates research with deaf community members that involves them and gives their perspective. The primary objective of this study was to map deaf pilot bilingual education programmes in Spain-one of the first countries to ratify the Convention on the Rights of Persons with Disabilities (United Nations. (2006) Convention on the Rights of Persons with Disabilities, Resolution A/RES/61/106.)-with particular attention to their compliance to the Convention's article 24. Following pre-testing, 516 key informants were surveyed by mail (response rate: 42.08%) by using a snow-ball key-informant approach, within a Participatory Action Research framework, at a national, regional and local level. The results show that although some schools have achieved recommended standards, bilingual programmes are in various stages of formulation and implementation and are far from being equally distributed across the country, with only four regions concentrating more than 70% of these practices. This uneven geographical distribution of programmes probably reflects more basic differences in the priority given by regions, provinces, and municipalities to the deaf community's needs and rights as an important policy objective and may reinforce or widen inequalities by favouring or discriminating rather than achieving access and equity for this noticeably overlooked community.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India

PubMed Central

2012-01-01

Introduction Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. Methodology A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Conclusion Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country. PMID:22449205

The Policy Impact of PISA: An Exploration of the Normative Effects of International Benchmarking in School System Performance. OECD Education Working Papers, No. 71

ERIC Educational Resources Information Center

Breakspear, Simon

2012-01-01

Little research has been done into how the results of the Programme for International Student Assessment (PISA) affect national educational reform and policy-making. This paper examines the normative impact of PISA by investigating how, and the extent to which , national policy actors use PISA in policies and practices, to evaluate and improve…

Strengthening public health education in population and reproductive health through an innovative academic partnership in Africa: the Gates partners experience.

PubMed

Oni, Gbolahan; Fatusi, Adesegun; Tsui, Amy; Enquselassie, Fikre; Ojengbede, Oladosu; Agbenyega, Tsiri; Ojofeitimi, Ebenezer; Taulo, Frank; Quakyi, Isabella

2011-01-01

Poor reproductive health constitutes one of the leading public health problems in the world, particularly in sub-Saharan Africa (SSA). We report here an academic partnership that commenced in 2003 between a US institution and six universities in SSA. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health (PRH) outcomes in low-resource settings. The partnership's core activities focused on increasing access to quality education, strengthening health research capacity and translating scholarship and science into policy and practices. Partnership programmes focused on the educational dimension of the human resources equation provide students with improved learning facilities and enhanced work environments and also provide faculty with opportunities for professional development and an enhanced capacity for curriculum delivery. By 2007, 48 faculty members from the six universities in SSA attended PRH courses at Johns Hopkins University, 93 PRH courses were offered across the six universities, 625 of their master's students elected PRH concentrations and 158 had graduated. With the graduation of these and future student cohorts, the universities in SSA will systematically be expanding the number of public health practitioners and strengthening programme effectiveness to resolve reproductive health needs. Some challenges facing the partnership are described in this article.

Caries Epidemiology and Community Dentistry: Chances for Future Improvements in Caries Risk Groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1.

PubMed

Splieth, Christian H; Christiansen, Jette; Foster Page, Lyndie A

2016-01-01

This paper reviews the first part of the outcomes of the ORCA Saturday Afternoon Symposium 2014 dealing with 'caries epidemiology and community dentistry: chances for future improvements in caries risk groups'. After the caries decline in many countries, there are remaining pockets of higher caries levels, mostly in the primary dentition and/or linked to a low socio-economic status (SES). The review into the evidence of caries-preventive measures clearly points to the use of fluorides, especially toothbrushing with fluoridated toothpaste and collective measures such as water fluoridation. In contrast to several unsuccessful high-risk approaches, community and public health programmes seem to be able to ensure a population-wide access and compliance in risk groups. Their simple and evidence-based measures mostly combine regular plaque removal and fluoride applications via toothbrushing, at least for children and adolescents. For the future, the common risk factor approach which addresses associations between oral health, social deprivation, diet, hygiene, smoking, alcohol use and stress should lead to combined efforts with other community health and education specialists. Further engagement with public policy, community leaders and administration is needed in order to strengthen healthy choices and behaviour, e.g. in 'healthy' schools and kindergartens. It seems advisable that these population programmes also aim at improving upstream factors. © 2016 S. Karger AG, Basel.

Private health insurance: implications for developing countries.

PubMed Central

Sekhri, Neelam; Savedoff, William

2005-01-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.

PubMed

Andersson, Neil; Cockcroft, Anne; Shea, Bev

2008-12-01

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Private health insurance: implications for developing countries.

PubMed

Sekhri, Neelam; Savedoff, William

2005-02-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

European Healthy Cities come to terms with health network governance.

PubMed

de Leeuw, Evelyne; Kickbusch, Ilona; Palmer, Nicola; Spanswick, Lucy

2015-06-01

A focus on good governance in the WHO European network of Healthy Cities mirrors the WHO Region's strategic emphasis-its member states in the Health 2020 strategy espouse governance for health as key. Healthy Cities adopted governance as a key value and approach to delivering specific health programmes and policies. This article reviews the extent to which they actually introduce and align governance concepts and approaches with their local government commitments. Healthy Cities show that better participation, policy-making and intersectoral action result from an emphasis on governance. This happens across the designated cities and is not limited to a certain class (in terms of population or geographical location) or the time they have been designated. The support of WHO in driving the governance agenda seems important, but no data are available to show that European Healthy Cities are different from other urban environments. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Rural poverty reduction through centrally sponsored schemes.

PubMed

Saxena, N C

2007-10-01

This paper discusses the evolving profile of poverty in India and reviews the national performance of selected anti-poverty programmes between 1997-1998 and 2005. For each programme, it outlines the budgetary allocation principle used for the States and districts and analyzes budgetary performance over the period. The main objective is to explore the extent to which the anti-poverty programmes are reaching their target groups effectively. Finally, it identifies the specific factors responsible for under-performance and provides a set of recommendations for policy makers and programme implementers which could help improve the outcomes of the schemes.

Livelihood opportunities amongst adults with and without disabilities in Cameroon and India: A case control study

PubMed Central

Banks, Lena Morgon; Kuper, Hannah; Murthy, G. V. S.; Sagar, Jayanthi; Oye, Joseph; Polack, Sarah

2018-01-01

Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian Setting. We undertook a population-based case–control study of adults (18+) with and without disabilities in North-West Cameroon and in Telangana State, India. We found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others. These findings are of crucial importance at this stage of the Sustainable Development Agenda, to ensure that the mandate of inclusive development is achieved. PMID:29630606

The views of genitourinary medicine (GUM) clinic users on unlinked anonymous testing for HIV: evidence from a pilot study of clinics in two English cities.

PubMed

Datta, Jessica; Kessel, Anthony; Wellings, Kaye; Nanchahal, Kiran; Marks, Dalya; Kinghorn, George

2011-11-01

A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT.

Do preschools differ in promoting children's physical activity? An instrument for the assessment of preschool physical activity programmes.

PubMed

Sterdt, Elena; Pape, Natalie; Kramer, Silke; Urban, Michael; Werning, Rolf; Walter, Ulla

2013-09-03

Preschools offer high potential for preventive interventions. However, little is known about the structure of preschool programmes to promote physical activity (PA) in preschoolers although almost all children aged three to six years spend one third of the day at preschool. The aim of this study was to determine whether and to what extent preschools implement systematic PA promotion measures using an instrument specifically developed to assess and systematize preschool PA programmes. In the cross-sectional study a baseline survey of preschool education policies was conducted to identify and assess the type and extent of PA programmes and opportunities in preschools in the State of Lower Saxony, Germany. An assessment instrument was developed to identify preschools with systematic PA programmes (type 1) and those without PA programmes (type 2) based on the following quality criteria: A) written PA policy, B) structured weekly PA offerings for all children; C) at least one qualified physical education teacher; D) PA-friendly indoor and outdoor facilities (exercise room, situational PA opportunities, outdoor areas, play equipment etc.), and E) structured PA promotion in place for at least two years. A third type of preschool that promotes PA in children to some extent (i.e., that meets the criteria partially but not completely) was classified as "preschools with limited PA programmes". 2415 preschools participated in the survey (response rate: 59%). The results show that 26% (n = 554) have a systematic PA programme while 3% (n = 64) have no PA programme. Most (71%, n = 1514) were classified as limited PA programme preschools. All three types of preschools differed significantly (p = .000) from each other in terms of size (small vs. large). Most of the preschools without PA programmes are small half-day preschools. The study investigated an assessment-instrument providing extensive insight into the nature, extent and routine practical implementation of PA promotion in preschools. The criteria used to evaluate preschool PA programmes are well-suited to identify the different preschool PA programme types and target areas in the field of PA promotion in which specific measures (teacher education, structured PA offerings, etc.) can be implemented in future interventions.

Philippines (country/area statements).

PubMed

1985-09-01

According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, the 1980 Philippine census enumerated 48.1 million persons, a more than 6-fold increase over the 7.6 million of 1903. The 1913-39 average intercensal growth rate of 2.22% declined during World War II but soared to 3.06% from 1948-60. The growth rate was 2.71% between 1975-80. The median age was 20.2 in 1903, 16.9 in 1970 and 18.6 in 1980. The crude birth rate declined from 46.0/1000 in 1960 to 34.8 in 1975, while the crude death rate declined from 13.7/1000 in 1960 to 9.3 in 1975. The average age of Filipino women at marriage increased from 23.2 in 1975 to 24 in 1978, causing a decline of the total fertility rate from 5.89 to 4.70. The infant mortality rate was expected to decline from 59.3 in 1983 to 54.2 in 1987. The Philippines was still 63% rural in 1980 despite the concentration of urban growth in Manila. As of 1983, the Philippine Overseas Employment Administration had processed 434,207 employment contracts, of which 65.5% were for production process workers, transport equipment operators, and laborers, 15.3% were for service workers, and 13.9% were for professional and technical workers. The Philippine Family Planning program aims to reduce population growth from an estimated 2.54% in 1983 to 1.92% by 1993 and to achieve replacement level fertility by 2010. As a result of the 1978 review of the Philippine Population Programme, the focus is now on longterm planning to ensure more significant and perceptible demographic impact of development programs and policies. The Population Education Program aims to inculcate values supporting family planning in the areas of family size and welfare, responsible parenthood, and delayed marriage, while the Adolescent Fertility Program seeks to reduce the incidence of early marriage and pregnancy. 3496 clinics, hospitals, and sterilization centers provide family planning and related services, primarily to married couples of reproductive age. Outreach personnel in the public and private sectors serve clients beyond the reach of clinics. More than 628,000 new acceptors were recruited in 1984, of whom 111,131 chose sterilization. There were 2,473,451 current users out of a total of 7,028,364 married couples of reproductive age for a prevalence rate of 35.19%. Family planning acceptors are eligible for small capital loans for income-generating projects. Various types of training programs are continuously given to program personnel by the Manpower Development Programme. The 4 basic policies of the population program are noncoercion, integration, multiagency participation, and unacceptability of abortion. The private sector has played an important role in formulation and implementation of policies.

School feeding, moving from practice to policy: reflections on building sustainable monitoring and evaluation systems.

PubMed

Gelli, Aulo; Espejo, Francisco

2013-06-01

To provide an overview of the status of monitoring and evaluation (M&E) of school feeding across sub-Saharan Africa and to reflect on the experience on strengthening M&E systems to influence policy making in low-income countries. Literature review on the M&E of school feeding programmes as well as data from World Food Programme surveys. Sub-Saharan Africa. Countries implementing school feeding. Only two randomized controlled impact evaluations have been implemented in sub-Saharan Africa. Where M&E data collection is underway, the focus is on process and service delivery and not on child outcomes. M&E systems generally operate under the Ministry of Education, with other Ministries represented within technical steering groups supporting implementation. There is no internationally accepted standardized framework for the M&E of school feeding. There have been examples where evidence of programme performance has influenced policy: considering the popularity of school feeding these cases though are anecdotal, highlighting the opportunity for systemic changes. There is strong buy-in on school feeding from governments in sub-Saharan Africa. In response to this demand, development partners have been harmonizing their support to strengthen national programmes, with a focus on M&E. However, policy processes are complex and can be influenced by a number of factors. A comprehensive but simple approach is needed where the first step is to ensure a valid mandate to intervene, legitimizing the interaction with key stakeholders, involving them in the problem definition and problem solving. This process has been facilitated through the provision of technical assistance and exposure to successful experiences through South–South cooperation and knowledge exchange.

Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities.

PubMed

Zapata Moya, Angel R; Navarro Yáñez, Clemente J

2017-03-01

Urban regeneration policies are area-based interventions addressing multidimensional problems. In this study, we analyse the impact of urban regeneration processes on the evolution of inequalities in mortality from certain causes. On the basis of Fundamental Cause Theory (FCT), our main hypothesis is that the impact of urban regeneration programmes will be more clearly observed on the causes of preventable deaths, as these programmes imply a direct or indirect improvement to a whole range of 'flexible resources' that residents in relevant areas have access to, and which ultimately may influence the inverse relationship between socioeconomic status and health. Using a quasi-experimental design and data from Longitudinal Statistics on Survival and Longevity of Andalusia (Spain), we analyse differences in the evolution of standard mortality ratios for preventable and less-preventable causes of premature death. This encompasses 59 neighbourhoods in 37 municipalities where urban regeneration projects were implemented in the last decade within the framework of three different programmes and in 59 counterparts where these policies were not implemented. As expected in line with FCT, there are no significant patterns in the evolution of internal differences in terms of less-preventable mortality. However, excessive preventable mortality strongly decreases in the neighbourhoods with intervention programmes, specifically in those where two or more projects were in force. This is even more apparent for women. The urban regeneration policies studied seem to contribute to reducing health inequity when the interventions are more integral in nature. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Education for Democratic Citizenship in Malawian Secondary Schools: Balancing Student Voice and Adult Privilege

ERIC Educational Resources Information Center

Namphande, Peter; Clarke, Linda; Farren, Sean; McCully, Alan

2017-01-01

In countries that embraced democracy after the fall of communism, education became a particular focus for policy change, particularly within their citizenship programmes. Schools that had been used to inculcate obedience to and unfailing support for authoritarian regimes were now being required to adopt citizenship programmes incorporating…

Managing Risk in Producing Concerts and Other Major Campus Events: A Guide for Student Programmers.

ERIC Educational Resources Information Center

German, Carol J.

1999-01-01

Offers suggestions for campus-activities programmers on how to minimize liability for problems with concerts and other student-planned campus events. Discussion covers prevention of monetary loss, breach of contract issues, and preventing personal injuries and property damage. Specific preventive actions and policies are discussed. (MSE)

Mapping Standardised Test Scores with Other Variables Using GIS

ERIC Educational Resources Information Center

Kerski, Joseph; Linn, Sophia; Gindele, Rick

2005-01-01

This article discusses the Mapping CSAP (Colorado Student Achievement Program) project, an extension of a grant-funded programme that sought to show the importance of a geographic perspective on public policy decision-making at the state level. In this programme, high school students were asked to grapple with current state issues in Colorado,…

Applying Information and Communication Technologies to Language Teaching and Research: An Overview

ERIC Educational Resources Information Center

Pareja-Lora, Antonio; Rodríguez-Arancón, Pilar; Calle-Martínez, Cristina

2016-01-01

Currently, there is an international change in education that includes the development of new learning programmes and policies, such as (a) bilingual education programmes, (b) the Bologna process, with an emphasis on a more autonomous way of learning, or (c) the systematic evaluation and assessment of students and educational results. These…

The Winds of Change: Higher Education Management Programmes in Europe

ERIC Educational Resources Information Center

Pausits, Attila; Pellert, Ada

2009-01-01

Amid the Bologna Process and as a direct effect of it, European higher education institutions have to rethink their core institutional policies in order to effectively deal with the increasing demands and needs of their "customers" and society at large. The higher education management programmes across Europe, with some specific needs…

Back to Basics: How Young Mothers Learn about Sex and Sexuality

ERIC Educational Resources Information Center

Dudley, James; Crowder, Amanda; Montgomery, Tchernavia R.

2014-01-01

Adolescent pregnancy continues to be a major concern for policy-makers, programme developers, helping professionals and society generally in the USA, especially in light of the US federal government's legislative emphasis on abstinence-only sex education until recently. Studies have found that abstinence-only programmes do not succeed in…

"Views from the Nano Edge": Women on Doctoral Preparation Programmes in Selected African Contexts

ERIC Educational Resources Information Center

Williamson, Charmaine

2016-01-01

The study explored the conceptual views of "critical mass", alongside micro experiences, of women, at a practice level, on a doctoral preparation programme which was implemented within the South African Development Community (SADC) and Ethiopian contexts. At the strategising level of policies, insufficient attention has been paid to the…

Who Withdraws from Initial Teacher Preparation Programmes and Why?

ERIC Educational Resources Information Center

Hobson, Andrew J.; Giannakaki, Marina-Stefania; Chambers, Gary N.

2009-01-01

Background: In recent years, withdrawal from initial teacher preparation (ITP) programmes, in England and elsewhere, has become a cause for concern amongst both ITP providers and policy-makers. Purpose: This paper seeks to enhance the presently underdeveloped evidence base on the causes of withdrawal from ITP and on the characteristics of student…

Global Learning and the School Curriculum

ERIC Educational Resources Information Center

Bourn, Douglas

2016-01-01

The global society of today is one that children and young people are aware of but this has not been fully recognised by education policy-makers despite the efforts and activities of many civil society organisations and the enthusiasm of teachers. Since 2010 in England, a government-sponsored programme, the Global Learning Programme, has been a…

Integrating mental health into primary care in Sverdlovsk

PubMed Central

2009-01-01

Introduction Mental disorders occur as frequently in Russia as elsewhere, but the common mental disorders, especially depression, have gone largely unrecognised and undiagnosed by policlinic staff and area doctors. Methods This paper describes the impact and sustainability of a multi-component programme to facilitate the integration of mental health into primary care, by situation appraisal, policy dialogue, development of educational materials, provision of a training programme and the publication of standards and good practice guidelines to improve the primary care of mental disorders in the Sverdlovsk region of the Russian Federation. Results The multi-component programme has resulted in sustainable training about common mental disorders, not only of family doctors but also of other cadres and levels of professionals, and it has been well integrated with Sverdlovsk's overall programme of health sector reforms. Conclusion It is possible to facilitate the sustainable integration of mental health into primary care within the Russian context. While careful adaptation will be needed, the approach adopted here may also hold useful lessons for policy makers seeking to integrate mental health within primary care in other contexts and settings. PMID:22477885

Measuring health and disability: supporting policy development. The European MHADIE project.

PubMed

Leonardi, Matilde

2010-01-01

Disability is a multi-dimensional phenomenon arising out of an interaction between the individual's health status and his environment: disability data must reflect this bio-psychosocial model. WHO's International Classification of Functioning, Disability and Health (ICF) provides the framework for documenting the interaction between health status and environmental features. MHADIE, a 3-year project supported by a EC 6th Framework Programme Grant, aimed at demonstrating the feasibility and utility of the ICF model in the measurement and description of disability. The ICF model was used as the structure for analysing existing population health surveys and education statistics data. ICF-based tools were used to describe disability in selected health conditions. MHADIE researchers showed that the ICF model is adequate for describing and measuring patterns of disability in clinical samples from different countries cross-sectionally and over time as well as feasible and useful in educational sectors. Valid and reliable information are essential to design, implement or evaluate policies to combat discrimination, promote integration and enhance opportunities. Results made it possible to produce a definition of disability as well as policy recommendations concerning how, in Europe and internationally, the existing sources of data can be harmonized with the ICF model.

Improving access to primary mental health care for Australian children.

PubMed

Bassilios, Bridget; Nicholas, Angela; Reifels, Lennart; King, Kylie; Spittal, Matthew J; Fletcher, Justine; Pirkis, Jane

2016-11-01

This study examines the uptake by children aged predominantly 0-11 years of an Australian primary mental health service - the Access to Allied Psychological Services programme - which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania.

PubMed Central

Rommelmann, Vanessa; Setel, Philip W.; Hemed, Yusuf; Angeles, Gustavo; Mponezya, Hamisi; Whiting, David; Boerma, Ties

2005-01-01

OBJECTIVE: To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS: Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS: In 2002-03 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION: Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. PMID:16184275

Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study.

PubMed

Hangulu, Lydia; Akintola, Olagoke

2017-04-19

In South Africa, a new primary health care (PHC) re-engineering initiative aims to scale up the provision of community-based care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide care to the largely poor and marginalised communities across the country. The provision of care will inevitably lead to an increase in the amount of health care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is care of a patient. CBC in South Africa is guided by the home-based care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health care waste management (HCWM) in CBC in South Africa from the policy-makers' and stakeholders' perspective. Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.

Eradication of tephritid fruit fly pest populations: outcomes and prospects.

PubMed

Suckling, David Maxwell; Kean, John M; Stringer, Lloyd D; Cáceres-Barrios, Carlos; Hendrichs, Jorge; Reyes-Flores, Jesus; Dominiak, Bernard C

2016-03-01

The number of insect eradication programmes is rising in response to globalisation. A database of arthropod and plant pathogen eradications covers 1050 incursion responses, with 928 eradication programmes on 299 pest and disease taxa in 104 countries (global eradication database b3.net.nz/gerda). A subset of the database was assembled with 211 eradication or response programmes against 17 species of fruit flies (Tephritidae) in 31 countries, in order to investigate factors affecting the outcome. The failure rate for fruit fly eradication programmes was about 7%, with 0% for Ceratitis capitata (n = 85 programmes) and 0% for two Anastrepha species (n = 12 programmes), but 12% for 13 Bactrocera species (n = 108 programmes). A number of intended eradication programmes against long-established populations were not initiated because of cost and other considerations, or evolved during the planning phase into suppression programmes. Cost was dependent on area, ranged from $US 0.1 million to $US 240 million and averaged about $US 12 million (normalised to $US in 2012). In addition to the routine use of surveillance networks, quarantine and fruit destruction, the key tactics used in eradication programmes were male annihilation, protein bait sprays (which can attract both sexes), fruit destruction and the sterile insect technique. Eradication success generally required the combination of several tactics applied on an area-wide basis. Because the likelihood of eradication declines with an increase in the area infested, it pays to invest in effective surveillance networks that allow early detection and delimitation while invading populations are small, thereby greatly favouring eradication success. © 2014 Society of Chemical Industry.

Sociocultural Comparison of Bilingual Education Policies and Programmes in Three Andean Countries and the United States.

ERIC Educational Resources Information Center

Minaya-Rowe, Liliana

1986-01-01

Presents a model of the sociocultural circumstances surrounding the development of language policies and planning and of bilingual education programs in the United States and three Andean countries: Peru, Bolivia, and Ecuador. (Author/CB)

Globalization, diet, and health: an example from Tonga.

PubMed Central

Evans, M.; Sinclair, R. C.; Fusimalohi, C.; Liava'a, V.

2001-01-01

The increased flow of goods, people, and ideas associated with globalization have contributed to an increase in noncommunicable diseases in much of the world. One response has been to encourage lifestyle changes with educational programmes, thus controlling the lifestyle-related disease. Key assumptions with this approach are that people's food preferences are linked to their consumption patterns, and that consumption patterns can be transformed through educational initiatives. To investigate these assumptions, and policies that derive from it, we undertook a broad-based survey of food-related issues in the Kingdom of Tonga using a questionnaire. Data on the relationships between food preferences, perception of nutritional value, and frequency of consumption were gathered for both traditional and imported foods. The results show that the consumption of health-compromising imported foods was unrelated either to food preferences or to perceptions of nutritional value, and suggests that diet-related diseases may not be amenable to interventions based on education campaigns. Given recent initiatives towards trade liberalization and the creation of the World Trade Organization, tariffs or import bans may not serve as alternative measures to control consumption. This presents significant challenges to health policy-makers serving economically marginal populations and suggests that some population health concerns cannot be adequately addressed without awareness of the effects of global trade. PMID:11584734

Globalization, diet, and health: an example from Tonga.

PubMed

Evans, M; Sinclair, R C; Fusimalohi, C; Liava'a, V

2001-01-01

The increased flow of goods, people, and ideas associated with globalization have contributed to an increase in noncommunicable diseases in much of the world. One response has been to encourage lifestyle changes with educational programmes, thus controlling the lifestyle-related disease. Key assumptions with this approach are that people's food preferences are linked to their consumption patterns, and that consumption patterns can be transformed through educational initiatives. To investigate these assumptions, and policies that derive from it, we undertook a broad-based survey of food-related issues in the Kingdom of Tonga using a questionnaire. Data on the relationships between food preferences, perception of nutritional value, and frequency of consumption were gathered for both traditional and imported foods. The results show that the consumption of health-compromising imported foods was unrelated either to food preferences or to perceptions of nutritional value, and suggests that diet-related diseases may not be amenable to interventions based on education campaigns. Given recent initiatives towards trade liberalization and the creation of the World Trade Organization, tariffs or import bans may not serve as alternative measures to control consumption. This presents significant challenges to health policy-makers serving economically marginal populations and suggests that some population health concerns cannot be adequately addressed without awareness of the effects of global trade.

Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV?

PubMed

Jacobson, Jerry O; Cueto, Carmen; Smith, Jennifer L; Hwang, Jimee; Gosling, Roly; Bennett, Adam

2017-01-18

To eliminate malaria, malaria programmes need to develop new strategies for surveillance and response appropriate for the changing epidemiology that accompanies transmission decline, in which transmission is increasingly driven by population subgroups whose behaviours place them at increased exposure. Conventional tools of malaria surveillance and response are likely not sufficient in many elimination settings for accessing high-risk population subgroups, such as mobile and migrant populations (MMPs), given their greater likelihood of asymptomatic infections, illegal risk behaviours, limited access to public health facilities, and high mobility including extended periods travelling away from home. More adaptive, targeted strategies are needed to monitor transmission and intervention coverage effectively in these groups. Much can be learned from HIV programmes' experience with "second generation surveillance", including how to rapidly adapt surveillance and response strategies to changing transmission patterns, biological and behavioural surveys that utilize targeted sampling methods for specific behavioural subgroups, and methods for population size estimation. This paper reviews the strategies employed effectively for HIV programmes and offers considerations and recommendations for adapting them to the malaria elimination context.

The regional distribution of doctors in Mexico, 1930-1990: a policy assessment.

PubMed

Nigenda, G

1997-02-01

The results of the doctor distributional policy in Mexico is evaluated. Despite the government's efforts to achieve a better distribution of doctors throughout the country between 1930 and 1990, important disparities still exist among geographic areas. Diverse factors ranging from the underdevelopment of some areas, to the resistance of doctors to leave the urban areas, are related to this unequal distribution. Early programmes aimed at redressing the original distribution in the 1930's had limited effects. In subsequent years, additional programmes were implemented. However, a lack of coordination and the short time span of many programmes produced only minor changes to the distributional pattern. Although in recent years the distribution has improved, southern states still suffer an acute scarcity while northern states have a relative abundance. Finally, the paper discusses how economic, political and social variables, as well as the structure of the health system, have shaped the current distribution of Mexican doctors.

National radon programmes and policies: the RADPAR recommendations.

PubMed

Bochicchio, F; Hulka, J; Ringer, W; Rovenská, K; Fojtikova, I; Venoso, G; Bradley, E J; Fenton, D; Gruson, M; Arvela, H; Holmgren, O; Quindos, L; McLaughlin, J; Collignan, B; Gray, A; Grosche, B; Jiranek, M; Kalimeri, K; Kephalopoulos, S; Kreuzer, M; Schlesinger, D; Zeeb, H; Bartzis, J

2014-07-01

Results from epidemiological studies on lung cancer and radon exposure in dwellings and mines led to a significant revision of recommendations and regulations of international organisations, such as WHO, IAEA, Nordic Countries, European Commission. Within the European project RADPAR, scientists from 18 institutions of 14 European countries worked together for 3 y (2009-12). Among other reports, a comprehensive booklet of recommendations was produced with the aim that they should be useful both for countries with a well-developed radon programme and for countries with little experience on radon issues. In this paper, the main RADPAR recommendations on radon programmes and policies are described and discussed. These recommendations should be very useful in preparing a national action plan, required by the recent Council Directive 2013/59/Euratom. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Acculturation and School Adjustment of Immigrant Youth in Six European Countries: Findings from the Programme for International Student Assessment (PISA).

PubMed

Schachner, Maja K; He, Jia; Heizmann, Boris; Van de Vijver, Fons J R

2017-01-01

School adjustment determines long-term adjustment in society. Yet, immigrant youth do better in some countries than in others. Drawing on acculturation research (Berry, 1997; Ward, 2001) and self-determination theory (Ryan and Deci, 2000), we investigated indirect effects of adolescent immigrants' acculturation orientations on school adjustment (school-related attitudes, truancy, and mathematics achievement) through school belonging. Analyses were based on data from the Programme for International Student Assessment from six European countries, which were combined into three clusters based on their migrant integration and multicultural policies: Those with the most supportive policies (Belgium and Finland), those with moderately supportive policies (Italy and Portugal), and those with the most unsupportive policies (Denmark and Slovenia). In a multigroup path model, we confirmed most associations. As expected, mainstream orientation predicted higher belonging and better outcomes in all clusters, whereas the added value of students' ethnic orientation was only observed in some clusters. Results are discussed in terms of differences in acculturative climate and policies between countries of settlement.

European Union research in support of environment and health: Building scientific evidence base for policy.

PubMed

Karjalainen, Tuomo; Hoeveler, Arnd; Draghia-Akli, Ruxandra

2017-06-01

Opinion polls show that the European Union citizens are increasingly concerned about the impact of environmental factors on their health. In order to respond and provide solid scientific evidence for the numerous policies related to the protection of human health and the environment managed at the Union level, the European Union made a substantial investment in research and innovation in the past two decades through its Framework Programmes for Research and Technological Development, including the current programme, Horizon 2020, which started in 2014. This policy review paper analysed the portfolio of forty collaborative projects relevant to environment and health, which received a total amount of around 228 million euros from the EU. It gives details on their contents and general scientific trends observed, the profiles of the participating countries and institutions, and the potential policy implications of the results obtained. The increasing knowledge base is needed to make informed policy decisions in Europe and beyond, and should be useful to many stakeholders including the scientific community and regulatory authorities. Copyright © 2017. Published by Elsevier Ltd.

Conventional wisdom is a poor predictor of the relationship between discipline policy, student misbehaviour and teacher stress.

PubMed

Hart, P M; Wearing, A J; Conn, M

1995-03-01

Will an effective discipline policy improve student misbehaviour and result in a reduction of teacher stress? It is commonly believed that student misbehaviour is a major cause of teacher stress, and that the degree of student misbehaviour is reflected in student suspension rates. Moreover, it is believed that student misbehaviour can be reduced by improving a school's discipline policy through the collaborative efforts of whole school communities. As a result of growing concern about student misbehaviour and teacher stress, a Whole School Approach to Discipline and Student Welfare programme was implemented throughout the Australian state of Victoria. This paper reports on the evaluation studies that were conducted to assess the effectiveness of the programme and examine the assumptions which underpinned its implementation. Data were obtained from 4,072 primary and secondary school teachers. Although longitudinal analyses suggested that the programme was effective in reducing teacher stress, there was no mean change in student misbehaviour. Structural equation analyses showed that there was little relationship between a school's discipline policy and the perceived level of student misbehaviour. It was also found that student suspension rates were not related to student misbehaviour, but could be predicted on the basis of a school's discipline policy and the self-esteem of teachers. Two and three wave causal analyses also demonstrated the problems associated with using cross-sectional research to support major policy decisions. Overall, these studies showed that there is little point in trying to reduce teacher stress by reducing student misbehaviour. Rather, it is more appropriate to develop a supportive organisational climate that enables teachers to cope with the student misbehaviour that confronts them.

Intelligent policy making? Key actors' perspectives on the development and implementation of an early years' initiative in Scotland's public health arena.

PubMed

Deas, L; Mattu, L; Gnich, W

2013-11-01

Increased political enthusiasm for evidence-based policy and action has re-ignited interest in the use of evidence within political and practitioner networks. Theories of evidence-based policy making and practice are being re-considered in an attempt to better understand the processes through which knowledge translation occurs. Understanding how policy develops, and practice results, has the potential to facilitate effective evidence use. Further knowledge of the factors which shape healthcare delivery and their influence in different contexts is needed. This paper explores the processes involved in the development of a complex intervention in Scotland's National Health Service (NHS). It uses a national oral health programme for children (Childsmile) as a case study, drawing upon key actors' perceptions of the influence of different drivers (research evidence, practitioner knowledge and values, policy, and political and local context) to programme development. Framework analysis is used to analyse stakeholder accounts from in-depth interviews. Documentary review is also undertaken. Findings suggest that Childsmile can be described as an 'evidence-informed' intervention, blending available research evidence with knowledge from practitioner experience and continual learning through evaluation, to plan delivery. The importance of context was underscored, in terms of the need to align with prevailing political ideology and in the facilitative strength of networks within the relatively small public health community in Scotland. Respondents' perceptions support several existing theoretical models of translation, however no single theory offered a comprehensive framework covering all aspects of the complex processes reported. Childsmile's use of best available evidence and on-going contribution to knowledge suggest that the programme is an example of intelligent policy making with international relevance. Copyright © 2013 Elsevier Ltd. All rights reserved.

Tuberculosis treatment outcome and health services: a comparison of displaced and settled population groups in Khartoum, Sudan.

PubMed

Bøhler, M; Mustafaa, S A; Mørkve, O

2005-01-01

The Sudan National Tuberculosis Programme serves internally displaced and settled populations in Khartoum, Sudan. To investigate whether treatment in the camps is satisfactory compared to the settled population and to World Health Organization (WHO) standards, and to map certain characteristics of the clinics that may explain differences in treatment outcome. A register analysis was done on sputum smear-positive and retreatment tuberculosis patients registered consecutively in the first and second quarters of 2000. The nine health facilities from which the patients were selected were investigated using a questionnaire. State tuberculosis officers were interviewed about regional treatment policies. Two hundred and ninety-five internally displaced and 154 settled patients from respectively five and four clinics were included. The cure and completion rates among new sputum smear-positive cases were significantly higher among displaced (65% and 9.3%) than among settled persons (43.5% and 21%). Displaced groups had better adherence to 5 and 8 month smear examinations, and the quantity of health education was higher in the camps than among the settled population. Tuberculosis treatment among the displaced population in Khartoum compares favourably with the neighbouring settled population, but both groups still face serious challenges to fulfil the WHO goals.

Physical Activity in Schools: A Qualitative Case Study of Eight Norwegian Schools' Experiences with the Implementation of a National Policy

ERIC Educational Resources Information Center

Larsen, Torill; Samdal, Oddrun; Tjomsland, Hege

2013-01-01

Purpose: Over the past decades numerous policies, programmes and interventions have been undertaken to increase students' participation in physical activity in school. Research shows that intervention effects are mostly related to the way in which the program or policy is implemented, nevertheless, few studies have focused on the implementation…

Policy Development, Theory and Practice in Environmental Adult Education: Reflections on the Learning for Environmental Action Programme from 1995 to the Present

ERIC Educational Resources Information Center

Clover, Darlene E.

2006-01-01

Contemporary neo-conservative and globalisation practices and policies have a powerful impact on every aspect of human life. Policies enacted by the governments to accumulate wealth have destroyed natural environments like nothing before. As the negative impact of neo-conservatism and globalisation grew on people's lives and environment, the…

Charting Teacher Education Policy in the Republic of Ireland with Particular Reference to the Impact of Economic Recession

ERIC Educational Resources Information Center

Clarke, Marie; Killeavy, Maureen

2012-01-01

Background: Teacher education is an area of concern both in the policy and practice domains in both international and national contexts. Internationally, there are a wide range teacher education programmes and there is also considerable diversity with reference to policy approaches that operationalise such provision. Purpose: This paper focuses on…

Congruence between National Policy for Science and Humanities Enrolment Ratio and Labour Market Demand in Ghana

ERIC Educational Resources Information Center

Alabi, Goski; Alabi, Joshua; Mohammed, Ibrahim

2013-01-01

The paper undertook a snapshot of the demand for various academic programmes on the labour market and compared this with national policy norms for enrolment in public universities in Ghana. The objective was to ascertain whether national higher education enrolments are responsive to the national policy target of 60:40 (Sciences : Humanities) or…

Community College Baccalaureate: A Fixed Effects, Multi-Year Study of the Influence of State Policy on Nursing Degree Production

ERIC Educational Resources Information Center

Daun-Barnett, Nathan

2011-01-01

For the past 10 years, a growing number of community colleges in the US have begun to offer baccalaureate degrees across a range of targeted programmes including business, education, and nursing. This study examines whether community college baccalaureate policies result in an increased production of nurses--currently a policy priority in nearly…

Language Policy at Times of Instability and Struggle: The Impact of Fluctuating Will and Competing Agendas on a Slovene Language Strategy

ERIC Educational Resources Information Center

Savski, Kristof

2017-01-01

This article analyses how the drafting and implementation of the Resolution for a National Language Policy Programme 2014-2018, a Slovene language strategy, were influenced by political instability and inter-institutional struggles. By conducting a historical ethnography to trace how different authors contributed to the policy text, and examining…

Literacy in the 21st century: Towards a dynamic nexus of social relations

NASA Astrophysics Data System (ADS)

Benavot, Aaron

2015-06-01

Literacy is an essential means of communication. It enables individuals, communities and institutions to interact, over time and across space, as they develop a web of social relations via language. Effective literacy policies, programmes and practices expand the scale of social communication and interaction. Thus, literacy thrives when a state of connectedness - or social nexus of relations - is forged and sustained among individuals, households, communities and social institutions. This paper provides an overview of recent literacy trends and challenges as well as core aspects of the policy strategies which seek to address them. It reviews the main barriers or complicating factors which limit the effective implementation of literacy policies. The paper describes how the notion of non-formal education, which frames many scholarly and policy accounts of adult literacy work today, is under-conceptualised. One result of this is a relatively undifferentiated view of literacy programmes and their specific non-formal components. The author argues that the concept of the social nexus of literacy is implicit in many analyses of literacy policies and strategies. Thus, well-defined, context-specific and sharply conceived literacy policies, which enhance the social nexus of literacy, are crucial for improving the effectiveness of literacy work.

Study protocol: using the Q-STEPS to assess and improve the quality of physical activity programmes for the elderly.

PubMed

Marques, Ana I; Rosa, Maria J; Amorim, Marlene; Soares, Pedro; Oliveira-Tavares, António; Santos, Rute; Mota, Jorge; Carvalho, Joana

2012-07-09

Aging is one of the most important and obvious phenomenon observed in our society. In the past years, there has been a growing concern in designing physical activity (PA) programmes for elderly people, because evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Accordingly, a growing body of literature points to the importance of a sound approach to planning and evaluation in order to improve the quality of PA programmes. However, while numerous PA programmes have been designed for the elderly in recent years, their evaluation has been scarce. Quality management processes and tools provide a practical way for organisations to assess, identify and shed light on the areas requiring improvement. The Quality Self-assessment Tool for Exercise Programmes for Seniors (Q-STEPS) seems to provide a framework tailored to evaluate PA programmes for the elderly. The primary purpose of this study is 1) to determine feasibility, acceptability and usability of the Q-STEPS. Secondary purposes of the study are: 2) to examine the quality of the PA programmes for elderly people developed by the Portuguese Local Administration over a three-year period of self-assessments in terms of: a) Enabler domains (Leadership, Policy and Strategy, People, Partnership and Resources, Processes); b) Result domains (Customer Results, People Results, Society Results and Key Performance Results); 3) to estimate the association between the use of Q-STEPS and some indicators relating to the elderly participants, during the three self-assessments, such as: attendance rates, physical fitness, health-related quality of life and the elderly's perceived quality of the programme. The study will be conducted in PA programmes for elderly adults from mainland Portuguese municipalities over a three-year period. The project will adopt a participative quality improvement approach that features annual learning cycles of: 1) self-assessment with the Q-STEPS; 2) feedback to and interpretation of results involving programme's staff; 3) action planning to achieve system changes; 4) implementation of strategies for change; and 5) review process through further self-assessment. The study will collect a range of process and outcome data that will be used to achieve the research aims. It is our understanding that the results of the Q-STEPS study will contribute directly to the evidence based on effectiveness of continuous quality improvement approaches, in order to improve customer satisfaction and adherence to PA programmes targeting the ageing population. This comprehensive evaluation will also add significant new knowledge regarding the characteristics associated with a sustainable public service.

Evaluation of the colorectal cancer screening Programme in the Basque Country (Spain) and its effectiveness based on the Miscan-colon model.

PubMed

Idigoras, I; Arrospide, A; Portillo, I; Arana-Arri, E; Martínez-Indart, L; Mar, J; de Koning, H J; Lastra, R; Soto-Gordoa, M; van der Meulen, M; Lansdorp-Vogelaar, I

2017-08-01

The population-based Basque Colorectal Cancer (CRC) Screening Programme started in 2009 with a biennial immunochemical quantitative test (FIT) biennial and colonoscopy under sedation in positive cases. The population target of 586,700 residents was from 50 to 69 years old and the total coverage was reached at the beginning of 2014. The aim of our study was to determine possible scenarios in terms of incidence, mortality and reduction of Life-years-Lost (L-y-L) in the medium and long term of CRC. Invitations were sent out by the Programme from 2009 to 2014, with combined organizational strategies. Simulation was done by MISCAN-colon (Microsimulation Screening Analysis) over 30 years comparing the results of screening vs no-screening, taking the population-based Cancer Registry into account. Lifetime population and real data from the Programme were used from 2008 to 2012. The model was run differentially for men and women. 924,416 invitations were sent out from 2009 to 2014. The average participation rate was 68.4%, CRC detection rate was 3.4% and the Advanced Adenoma detection rate was 24.0‰, with differences observed in sex and age. Future scenarios showed a higher decrease of incidence (17.2% vs 14.7%), mortality (28.1% vs 22.4%) and L-y-L (22.6% vs 18.4%) in men than women in 2030. The Basque Country CRC Programme results are aligned to its strategy and comparable to other programmes. MISCAN model was found to be a useful tool to predict the benefits of the programme in the future. The effectiveness of the Programme has not been formally established as case control studies are required to determine long term benefits from the screening strategy.

Educating for action: Aligning skills with policies for sustainable development in the Danube river basin.

PubMed

Irvine, Kenneth; Weigelhofer, Gabriele; Popescu, Ioana; Pfeiffer, Ellen; Păun, Andrei; Drobot, Radu; Gettel, Gretchen; Staska, Bernadette; Stanica, Adrian; Hein, Thomas; Habersack, Helmut

2016-02-01

Sustainable river basin management depends on knowledge, skills and education. The DANCERS project set out to identify feasible options for achieving education for sustainable water management across the Danube river basin, and its integration with broader education and economic development. The study traced the historic, regulatory and educational landscape of water management in the basin, contrasting it with the complex political decision-making, data-heavy decision support, learning-centred collaboration, and information-based participation that are all inherent components of Integrated Water Resource Management (IWRM). While there is a wide range of educational opportunities and mobility schemes available to individuals, there is no coherent network related to training in water management and sustainable development in the study region. Progress in addressing the multi-layered environmental challenges within the basin requires further aligning of economic, environmental and educational policies, advancing the EU Bologna Process across the region, and the development of dedicated training programmes that combine technical and relational skills. The DANCERS project identified key short and medium term needs for education and research to support progressive adoption of sustainable development, and the necessary dialogue across the public and private sectors to align policies. These include the development of new education networks for masters and PhD programmes, including joint programmes; improved access to technical training and life-long learning programmes for skills development; developing formalized and certified competency structures and associated accreditation of institutions where such skilled individuals work; and developing a co-ordinated research infrastructure and pan-basin programme for research for water management and sustainable development. Copyright © 2015 Elsevier B.V. All rights reserved.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE).

PubMed

Paquette-Warren, Jann; Harris, Stewart B; Naqshbandi Hayward, Mariam; Tompkins, Jordan W

2016-10-01

Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real-world evaluation. Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real-world comprehensive evaluations in health care settings. The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub-steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built-in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale-up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE)

PubMed Central

Harris, Stewart B.; Naqshbandi Hayward, Mariam; Tompkins, Jordan W.

2016-01-01

Abstract Rationale, aims and objectives Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real‐world evaluation. Method Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real‐world comprehensive evaluations in health care settings. Results The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub‐steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built‐in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. Conclusions This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale‐up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. PMID:26804339

'Scaling-up is a craft not a science': Catalysing scale-up of health innovations in Ethiopia, India and Nigeria.

PubMed

Spicer, Neil; Bhattacharya, Dipankar; Dimka, Ritgak; Fanta, Feleke; Mangham-Jefferies, Lindsay; Schellenberg, Joanna; Tamire-Woldemariam, Addis; Walt, Gill; Wickremasinghe, Deepthi

2014-11-01

Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution - implementers must embrace multiple activities, and require substantial support from donors and governments in doing so. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Public health competencies and contents in Spanish university degree programmes of Veterinary Medicine].

PubMed

Davó-Blanes, María Del Carmen; Vives-Cases, Carmen; Huerta, Belén

2017-04-19

To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into the Veterinary Medicine degree training. The 3rd Forum of University Professors of Public Health was held at the School of Veterinary Medicine of the University of Cordoba (12-13 January 2016). Forty-two university professors and lecturers from nine Spanish universities with veterinary degrees participated in the forum. They were divided into five working groups during three working sessions to identify and classify core public health competencies for the Veterinary Medicine degree, propose public health contents for the identified competencies and organize such contents in thematic blocks. The results were discussed in different plenary sessions. The highest number of core competencies was identified in the activities related to the following public health functions: «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organized into five units: 1) Fundamentals of public health; 2) Study and research in public health; 3) Production, animal health and environment; 4) Food security; and 5) Health education. The public health core competencies and contents identified in this Forum may be considered as a starting point to update public health training programmes for future veterinary professionals. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Fitness to practice of medical graduates: one programme's approach.

PubMed

Braatvedt, Claire; Poole, Phillippa; Merry, Alan; Gorman, Des; Reid, Papaarangi; Bagg, Warwick

2014-11-07

Doctors must ensure they are fit to practise medicine. There is a relationship between unprofessional behaviour at medical school and in subsequent medical practice. This study describes one programme's Fitness to Practice (FtP) policy and outcomes since inception in 2005. FtP notifications were classified into: health or personal; professional attitudes, or external issues. Seriousness was classified as non-critical, critical or extraordinarily critical. Anonymous data were extracted and analysed from a confidential FtP database. There were 157 FtP notifications involving 132 (5.5%) students. 87.2% were for issues with professional attitudes and 80.3% were non-critical. 17 students received more than one FtP notification. Students in clinical years were over-represented (p<0.0001) as were males (57% vs. 43%: p=0.0286). 96% of students continued the programme after remedial action. Two students were excluded from the programme on FtP grounds. The national regulatory body was notified of nine individual students with the potential for on- going FtP concerns. Over 9 years, 5.5% of medical students received a FtP notification, with most of these isolated non-critical incidents of a professional nature. A small subset of students had repeated or serious concerns, underscoring the need for a FtP policy in any medical programme.

Change of strategy is required for malaria elimination: a case study in Purworejo District, Central Java Province, Indonesia.

PubMed

Murhandarwati, E Elsa Herdiana; Fuad, Anis; Sulistyawati; Wijayanti, Mahardika Agus; Bia, Michael Badi; Widartono, Barandi Sapta; Kuswantoro; Lobo, Neil F; Supargiyono; Hawley, William A

2015-08-16

Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity. The regional deadline for malaria elimination for Java island, given the steady decrease of malaria cases, was the end of 2015. Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage. This study documents factors that affect incidence and spatial distribution of malaria in Purworejo, such as geomorphology, topography, health system issues, and identifies potential constraints and challenges to achieve the elimination stage, such as inter-districts coordination, decentralization policy and allocation of financial resources for the programme. Historical malaria data from 2007 to 2011 were collected through secondary data, in-depth interviews and focus group discussions during study year (2010-2011). Malaria cases were mapped using the village-centroid shape file to visualize its distribution with geomorphologic characteristics overlay and spatial distribution of malaria. API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern. The spatiotemporal pattern of malaria cases in Purworejo and the adjacent districts demonstrate repeated concentrated occurrences of malaria in specific areas from 2007 to 2011. District health system issues, i.e., suboptimal coordination between primary care and referral systems, suboptimal inter-district collaboration for malaria surveillance, decentralization policy and the lack of resources, especially district budget allocations for the malaria programme, were major constraints for programme sustainability. A new malaria elimination approach that fits the local disease transmission, intervention and political system is required. These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers.

PubMed

Thiam, Sylla; Kimotho, Victoria; Gatonga, Patrick

2013-10-03

Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness.

Health policies on dialysis modality selection: a nationwide population cohort study

PubMed Central

Lin, Yi-Chun; Lin, Yen-Chung; Kao, Chih-Chin; Chen, Hsi-Hsien; Hsu, Chih-Cheng; Wu, Mai-Szu

2017-01-01

Objectives In Taiwan, peritoneal dialysis (PD) and haemodialysis are fully accessible to patients with end-stage renal disease. However, the usage of PD is considered low in Taiwan. Since 2005, 4 major policies have been implemented by Taiwan's Ministry of Health and Welfare, namely a multidisciplinary predialysis care programme and usage increasing the PD incidence as a key performance indicator (KPI) for hospital accreditation, both of which were implemented in 2006; reimbursement of the glucose-free dialysate, icodextrin that was implemented in 2007; and insurance reimbursement for renting automated PD machines that was implemented in 2008. The aim of this study was to analyse the associations between the PD promotional policies and the actual PD selection rates. Setting We analysed data within the Taiwan Renal Registry Data System from 2006 to 2013, focusing on the PD incidence in relation to the timings of the 4 PD promotional policies; then we stratified the results according to age, sex and the presence of diabetes mellitus. Participants From 2006 to 2013, 115 565 patients were enrolled in this study. The mean (SD) age of patients on PD was 54.6 (15.7) years. Results During the time frame in which the 4 PD promotional policies were implemented, the PD incidence increased from 12.8% in 2006 to 15.1% in 2009. The PD incidence started to decline in 2010 (13.8%) when the hospital accreditation policy was repealed. The 3 remaining policies were weakly associated with the PD incidence. The observational analysis determined that the patients' ages, sexes and diabetes mellitus incidence rates were relatively stable from 2006 to 2013. Conclusions Of the 4 health policies intended to promote PD usage, using increasing the PD incidence as a KPI for hospital accreditation had the strongest association with the PD incidence. PMID:28077410

The global nutrition transition: trends, disease burdens and policy interventions.

PubMed

Ronto, Rimante; Wu, Jason Hy; Singh, Gitanjali M

2018-03-06

Non-communicable diseases (NCD) have increased dramatically in developed and developing countries. Unhealthy diet is one of the major factors contributing to NCD development. Recent evidence has identified deterioration in aspects of dietary quality across many world regions, including low- and middle-income countries (LMIC). Most burdens of disease attributable to poor diet can be prevented or delayed as they occur prematurely. Therefore, it is important to identify and target unhealthy dietary behaviours in order to have the greatest impact. National dietary-related programmes have traditionally focused on micronutrient deficiency and food security and failed to acknowledge unhealthy dietary intakes as a risk factor that contributes to the development of NCD. Inadequate intakes of healthy foods and nutrients and excess intakes of unhealthy ones are commonly observed across the world, and efforts to reduce the double burden of micronutrient deficiency and unhealthy diets should be a particular focus for LMIC. Interventions and policies targeting whole populations are likely to be the most effective and sustainable, and should be prioritized. Population-based approaches such as health information and communication campaigns, fiscal measures such as taxes on sugar-sweetened beverages, direct restrictions and mandates, reformulation and improving the nutrient profile of food products, and standards regulating marketing to children can have significant and large impacts to improve diets and reduce the incidence of NCD. There is a need for more countries to implement population-based effective approaches to improve current diets.

Developing lay health worker policy in South Africa: a qualitative study

PubMed Central

2012-01-01

Background Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process. Methods The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically. Results Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system. Conclusion LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process. PMID:22410185

International Statements on Disability Policy.

ERIC Educational Resources Information Center

Rehabilitation International, New York, NY.

The document brings together key policy documents related to disability proposed by the bodies of the United Nations system and of major nongovernmental organizations. Statements from nine United Nations agencies are presented: General Assembly; Economic and Social Council; Development Programme; World Conference of Decade for Women; Economic and…

SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address the use of evidence to inform judgements about the balance between the pros and cons of policy and programme options. We suggest five questions that can be considered when making these judgements. These are: 1. What are the options that are being compared? 2. What are the most important potential outcomes of the options being compared? 3. What is the best estimate of the impact of the options being compared for each important outcome? 4. How confident can policymakers and others be in the estimated impacts? 5. Is a formal economic model likely to facilitate decision making? PMID:20018106

Post-conflict health reconstruction: search for a policy.

PubMed

Rubenstein, Leonard S

2011-10-01

Despite increasing experience in health reconstruction in societies emerging from conflict, the policy basis for investing in the development of equitable and effective health systems in the wake of war remains unsettled. Consideration of post-conflict health reconstruction is almost entirely absent in donor policies on global health. Practically by default, health programmes are seen increasingly as an element of stabilisation and security interventions in the aftermath of armed conflict. That perspective, however, lacks an evidence base and can skew health programmes towards short-term security and stabilisation goals that have a marginal impact and violate the principles of equity, non-discrimination, and quality, which are central to sound health systems and public acceptance of them. A better approach is to ground policy in legitimacy, viewing health both as a core social institution and one that, if developed according to human rights principles, including equity, non-discrimination, participation and accountability, can advance the effectiveness and the quality of governance in the emerging state. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

The introduction of dengue vaccine may temporarily cause large spikes in prevalence.

PubMed

Pandey, A; Medlock, J

2015-04-01

A dengue vaccine is expected to be available within a few years. Once vaccine is available, policy-makers will need to develop suitable policies to allocate the vaccine. Mathematical models of dengue transmission predict complex temporal patterns in prevalence, driven by seasonal oscillations in mosquito abundance. In particular, vaccine introduction may induce a transient period immediately after vaccine introduction where prevalence can spike higher than in the pre-vaccination period. These spikes in prevalence could lead to doubts about the vaccination programme among the public and even among decision-makers, possibly impeding the vaccination programme. Using simple dengue transmission models, we found that large transient spikes in prevalence are robust phenomena that occur when vaccine coverage and vaccine efficacy are not either both very high or both very low. Despite the presence of transient spikes in prevalence, the models predict that vaccination does always reduce the total number of infections in the 15 years after vaccine introduction. We conclude that policy-makers should prepare for spikes in prevalence after vaccine introduction to mitigate the burden of these spikes and to accurately measure the effectiveness of the vaccine programme.

Nutritional surveillance.

PubMed

Mason, J B; Mitchell, J T

1983-01-01

The concept of nutritional surveillance is derived from disease surveillance, and means "to watch over nutrition, in order to make decisions that lead to improvements in nutrition in populations". Three distinct objectives have been defined for surveillance systems, primarily in relation to problems of malnutrition in developing countries: to aid long-term planning in health and development; to provide input for programme management and evaluation; and to give timely warning of the need for intervention to prevent critical deteriorations in food consumption. Decisions affecting nutrition are made at various administrative levels, and the uses of different types of nutritional surveillance information can be related to national policies, development programmes, public health and nutrition programmes, and timely warning and intervention programmes. The information should answer specific questions, for example concerning the nutritional status and trends of particular population groups.Defining the uses and users of the information is the first essential step in designing a system; this is illustrated with reference to agricultural and rural development planning, the health sector, and nutrition and social welfare programmes. The most usual data outputs are nutritional outcome indicators (e.g., prevalence of malnutrition among preschool children), disaggregated by descriptive or classifying variables, of which the commonest is simply administrative area. Often, additional "status" indicators, such as quality of housing or water supply, are presented at the same time. On the other hand, timely warning requires earlier indicators of the possibility of nutritional deterioration, and agricultural indicators are often the most appropriate.DATA COME FROM TWO MAIN TYPES OF SOURCE: administrative (e.g., clinics and schools) and household sample surveys. Each source has its own advantages and disadvantages: for example, administrative data often already exist, and can be disaggregated to village level, but are of unknown representativeness and often cannot be linked with other variables of interest; sample surveys provide integrated data of more or less known representativeness, but sample sizes usually do not allow disaggregation to, for example, specific villages. A combination of these sources, with a capability for ad hoc surveys (formal or informal) is often the best solution. Finally, much depends on adequate facilities for data analysis, even though simple, comprehensible data outputs are what is required. Intersectoral cooperation is needed to provide realistic options for the decision-making process.

Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa.

PubMed

Theiss-Nyland, Katherine; Lynch, Michael; Lines, Jo

2016-05-04

In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels.

Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy.

PubMed

Cáceres, Carlos F; Borquez, Annick; Klausner, Jeffrey D; Baggaley, Rachel; Beyrer, Chris

2016-01-01

In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives. Those guidelines present a timely challenge to health systems for the scaling up of not only treatment for every person living with HIV infection but also the offer of PrEP to those at substantial risk. Delivery and uptake of both universal antiretroviral therapy (ART) and PrEP will require nation-wide commitment and could reinvigorate health systems to develop more comprehensive "combination prevention" programmes and support wider testing linked to both treatments and other prevention options for populations at highest risk who are currently not accessing services. Various gaps in current health systems will need to be addressed to achieve strategic scale-up of PrEP, including developing prioritization strategies, strengthening drug regulations, determining cost and funding sources, training health providers, supporting user adherence and creating demand. The initial steps in the scale-up of PrEP globally suggest feasibility, acceptability and likely impact. However, to prevent setbacks in less well-resourced settings, countries will need to anticipate and address challenges such as operational and health systems barriers, drug cost and regulatory policies, health providers' openness to prescribing PrEP to populations at substantial risk, demand and legal and human rights issues. Emerging problems will require creative solutions and will continue to illustrate the complexity of PrEP implementation.

Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy

PubMed Central

Cáceres, Carlos F; Borquez, Annick; Klausner, Jeffrey D; Baggaley, Rachel; Beyrer, Chris

2016-01-01

Background In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. Discussion The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives. Those guidelines present a timely challenge to health systems for the scaling up of not only treatment for every person living with HIV infection but also the offer of PrEP to those at substantial risk. Delivery and uptake of both universal antiretroviral therapy (ART) and PrEP will require nation-wide commitment and could reinvigorate health systems to develop more comprehensive “combination prevention” programmes and support wider testing linked to both treatments and other prevention options for populations at highest risk who are currently not accessing services. Various gaps in current health systems will need to be addressed to achieve strategic scale-up of PrEP, including developing prioritization strategies, strengthening drug regulations, determining cost and funding sources, training health providers, supporting user adherence and creating demand. Conclusions The initial steps in the scale-up of PrEP globally suggest feasibility, acceptability and likely impact. However, to prevent setbacks in less well-resourced settings, countries will need to anticipate and address challenges such as operational and health systems barriers, drug cost and regulatory policies, health providers’ openness to prescribing PrEP to populations at substantial risk, demand and legal and human rights issues. Emerging problems will require creative solutions and will continue to illustrate the complexity of PrEP implementation. PMID:27760685

Knowledge exchange in the Pacific: The TROPIC (Translational Research into Obesity Prevention Policies for Communities) project

PubMed Central

2012-01-01

Background Policies targeting obesogenic environments and behaviours are critical to counter rising obesity rates and lifestyle-related non-communicable diseases (NCDs). Policies are likely to be most effective and enduring when they are based on the best available evidence. Evidence-informed policy making is especially challenging in countries with limited resources. The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aims to implement and evaluate a tailored knowledge-brokering approach to evidence-informed policy making to address obesity in Fiji, a Pacific nation challenged by increasingly high rates of obesity and concomitant NCDs. Methods The TROPIC project draws on the concept of ‘knowledge exchange’ between policy developers (individuals; organisations) and researchers to deliver a knowledge broking programme that maps policy environments, conducts workshops on evidence-informed policy making, supports the development of evidence-informed policy briefs, and embeds evidence-informed policy making into organisational culture. Recruitment of government and nongovernment organisational representatives will be based on potential to: develop policies relevant to obesity, reach broad audiences, and commit to resourcing staff and building a culture that supports evidence-informed policy development. Workshops will increase awareness of both obesity and policy cycles, as well as develop participants’ skills in accessing, assessing and applying relevant evidence to policy briefs. The knowledge-broking team will then support participants to: 1) develop evidence-informed policy briefs that are both commensurate with national and organisational plans and also informed by evidence from the Pacific Obesity Prevention in Communities project and elsewhere; and 2) collaborate with participating organisations to embed evidence-informed policy making structures and processes. This knowledge broking initiative will be evaluated via data from semi-structured interviews, a validated self-assessment tool, process diaries and outputs. Discussion Public health interventions have rarely targeted evidence-informed policy making structures and processes to reduce obesity and NCDs. This study will empirically advance understanding of knowledge broking processes to extend evidence-informed policy making skills and develop a suite of national obesity-related policies that can potentially improve population health outcomes. PMID:22830984

Use of mass media campaigns to change health behaviour

PubMed Central

Wakefield, Melanie A.; Loken, Barbara; Hornik, Robert C.

2014-01-01

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages. PMID:20933263

Reframing noncommunicable diseases and injuries for the poorest Malawians: the Malawi National NCDI Poverty Commission.

PubMed

Cundale, Katie; Wroe, Emily; Matanje-Mwagomba, Beatrice L; Muula, Adamson S; Gupta, Neil; Berman, Josh; Kasomekera, Noel; Masiye, Jones

2017-06-01

Noncommunicable diseases and injuries (NCDIs) account for nearly 70% of deaths worldwide, with an estimated 75% of these deaths occurring in low- and middle-income countries. Globally, the burden of disease from noncommunicable diseases (NCDs) is most often caused by the "big 4," namely: diabetes, cardiovascular diseases, cancer, and chronic lung diseases. However, in Malawi, these 4 conditions account for only 29% of the NCDI disease burden. The Malawi National NCDI Poverty Commission was launched in November 2016 and will describe and evaluate the current NCDI situation in Malawi, with a focus on the poorest populations. The National Commission will investigate which NCDIs cause the biggest burden, which are more present in the young, and which interventions are available to avert death and disability from NCDIs in Malawi, particularly among the poorest segments of the population. The evidence gained through the work of this Commission will help inform research, policy, and programme interventions, all through an advocacy lens, as we strive to address the impact of NCDIs among all populations in Malawi.

Use of mass media campaigns to change health behaviour.

PubMed

Wakefield, Melanie A; Loken, Barbara; Hornik, Robert C

2010-10-09

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages. Copyright © 2010 Elsevier Ltd. All rights reserved.

Cancer patterns, trends, and transitions in Peru: a regional perspective.

PubMed

Piñeros, Marion; Ramos, Willy; Antoni, Sébastien; Abriata, Graciela; Medina, Luis E; Miranda, J Jaime; Payet, Eduardo; Bray, Freddie

2017-10-01

Peru, like several other South American countries, is experiencing remarkable population growth, ageing, and urbanisation, which has given rise to profound changes in its epidemiological profile. Prostate and breast cancer are the most frequent cancers in men and women, respectively, in Lima and Arequipa, the two areas with population-based cancer registries. However, infection-associated cancers (cervix and stomach) are also common, and rank highest in the national cancer mortality profile. Although a foundation of surveillance informs cancer-control initiatives in Peru, improvements in the vital statistics system, and the quality and use of incidence data for the planning and assessment of cancer prevention and control actions, are needed. Existing population-based cancer registries in Lima and Arequipa, and linkages to the established national mandatory cancer reporting system, are crucial for the collection of high-quality data on national cancer incidence. The delivery of effective cancer prevention and control measures requires sustained investment in the collection of high-quality data capable of informing policies and driving research programmes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Will European agricultural policy for school fruit and vegetables improve public health? A review of school fruit and vegetable programmes.

PubMed

de Sa, Joia; Lock, Karen

2008-12-01

For the first time, public health, particularly obesity, is being seen as a driver of EU agricultural policy. In 2007, European Ministers of Agriculture were asked to back new proposals for school fruit and vegetable programmes as part of agricultural reforms. In 2008, the European Commission conducted an impact assessment to assess the potential impact of this new proposal on health, agricultural markets, social equality and regional cohesion. A systematic review of the effectiveness of interventions to promote fruit and/or vegetable consumption in children in schools, to inform the EC policy development process. School schemes are effective at increasing both intake and knowledge. Of the 30 studies included, 70% increased fruits and vegetables (FV) intake, with none decreasing intake. Twenty-three studies had follow-up periods >1 year and provide some evidence that FV schemes can have long-term impacts on consumption. Only one study led to both increased fruit and vegetable intake and reduction in weight. One study showed that school fruit and vegetable schemes can also help to reduce inequalities in diet. Effective school programmes have used a range of approaches and been organized in ways which vary nationally depending on differences in food supply chain and education systems. EU agriculture policy for school fruits and vegetables schemes should be an effective approach with both public health and agricultural benefits. Aiming to increase FV intake amongst a new generation of consumers, it will support a range of EU policies including obesity and health inequalities.

Comparative Education on the Map of Teacher Preparation Programme in Kuwait

ERIC Educational Resources Information Center

Hamad, Al Rashid

2013-01-01

Comparative education represents one of the main topics included in teacher preparation programmes in most countries. This subject is critical for future teachers because it represents a window through which learners can look at other educational systems and see how they are managed and what sort of policies and educational philosophies are used.…

The Politics of the Academies Programme: Natality and Pluralism in Education Policy-Making

ERIC Educational Resources Information Center

Gunter, Helen M.; McGinity, Ruth

2014-01-01

Our investigations into the politics of the Academies Programme in England have generated thinking that draws on data about the conversion process from two projects. We engage with an early City Academy that replaced two "failing" schools, and a recent Academy that replaced a "successful" high school. We deploy Hannah Arendt's…