Capacity Building Efforts Research Articles

Pandemics, infodemics and health promotion.

The COVID‐19 pandemic and the accompanying infodemic are significant public health issues. The COVID‐19 infodemic has been prolific from early in the pandemic response, and has continued to escalate during vaccine rollout. COVID‐19 is the first pandemic in the social media era, expediting the need for effective measures to manage the high volume of information and misinformation. To address the infodemic, the World Health Organization (WHO) and others have commenced a comprehensive program of work, building capacity, raising awareness and developing new tools and methods. As part of the WHO capacity building effort, they have developed a comprehensive infodemic manager training program. The authors of this paper are Australian alumni from the first two training courses, all authors have health promotion backgrounds. Health Promotion Practitioners are uniquely positioned to build on existing skills, knowledge and reach to develop preventative strategies to help mitigate infodemics. This paper offers our combined perspectives on why the infodemic is a significant health promotion concern and the role we believe Health Promotion Practitioners can play in managing and mitigating the infodemic.

Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework.

BackgroundBuilding community capacity in secondary schools is a promising strategy for the sustainable implementation of school-based health promotion. The Fit Lifestyle at School and at Home (FLASH) intervention explored how building community capacity works for the prevention of overweight following four strategies: leadership, participatory school culture, tailored health-promotion activities, and local networks. This study evaluates the intervention's impact on community capacity and capacity-building processes over a period of 3 years, as well as its effects on adolescents' BMI and waist circumference.MethodsA mixed-methods design guided by the RE-AIM framework was used. Impact on community capacity was evaluated with semi-structured interviews at the start and end of the intervention and analyzed using an anchored coding scale. Capacity-building processes were evaluated using interviews, journals, questionnaires, and the minutes of meetings. The effects on BMI z-scores and waist circumference were evaluated using a quasi-experimental design comparing an intervention (IG) and reference group (RG), based on multi-level analyses.ResultsCommunity capacity improved across all intervention schools but varied between capacity-building strategies. Leadership recorded the greatest improvements, aided by the appointment of Healthy School Coordinators, who increasingly focused on coordinating processes and fostering collaborations. Participatory school culture also improved through the adoption and implementation of participatory methods and a general increase in awareness concerning the importance of the Healthy School approach. Although additional health-promotion activities were implemented, stakeholders struggled with tailoring these to the specific dynamics of their schools. Limited improvements were observed in setting-up local networks that could help schools encourage healthy behavior among pupils. Differences in BMI z-scores between IG and RG over the total sample were negligible whereas waist circumference increased slightly more in IG (0.99 cm, 95% CI [.04; 1.93]). However, differences were inconsistent over time and between cohorts.ConclusionsThis study highlights the potential of building community capacity. It emphasizes that this is a process in which stakeholders must become acquainted with new leadership roles and responsibilities. To navigate this process, schools need support in improving communication, establishing local networks, and sustaining capacity-building efforts in school policy.Trial registrationISRCTN67201841; date registered: 09/05/2019, retrospectively registered.

Capacity building in low- and middle-income countries: The essentials of sustainable education programs.

NPs are an essential resource in the organization and creation of capacity-building efforts to improve healthcare across the globe. There are limited data to guide the creation of effective supplementary education projects. Recent evidence highlights the essential components of sustainability, curriculum development, and program evaluation.

Providing Neurocritical Care in Resource-Limited Settings: Challenges and Opportunities.

Acute neurologic illnesses (ANI) contribute significantly to the global burden of disease and cause disproportionate death and disability in low-income and middle-income countries (LMICs) where neurocritical care resources and expertise are limited. Shifting epidemiologic trends in recent decades have increased the worldwide burden of noncommunicable diseases, including cerebrovascular disease and traumatic brain injury, which coexist in many LMICs with a persistently high burden of central nervous system infections such as tuberculosis, neurocysticercosis, and HIV-related opportunistic infections and complications. In the face of this heavy disease burden, many resource-limited countries lack the infrastructure to provide adequate care for patients with ANI. Major gaps exist between wealthy and poor countries in access to essential resources such as intensive care unit beds, neuroimaging, clinical laboratories, neurosurgical capacity, and medications for managing complex neurologic emergencies. Moreover, many resource-limited countries face critical shortages in health care workers trained to manage neurologic emergencies, with subspecialized neurocritical care expertise largely absent outside of high-income countries. Numerous opportunities exist to overcome these challenges through capacity-building efforts that improve outcomes for patients with ANI in resource-limited countries. These include research on needs and best practices for ANI management in LMICs, developing systems for effective triage, education and training to expand the neurology workforce, and supporting increased collaboration and data sharing among LMIC health care workers and systems. The success of these efforts in curbing the disproportionate and rising impact of ANI in LMICs will depend on the coordinated engagement of the global neurocritical care community.

Linking science and action to improve public health capacity for climate preparedness in lower- and middle-income countries

ABSTRACT By 2030, the direct adaptation costs to the health sector due to climate change are expected to cost between USD$2 to USD$4 billion a year. People in many low- and middle-income countries already suffer from several health challenges, such as malnutrition and a high occurrence of infectious diseases, challenges that will be intensified by climate change and variability. Furthermore, these countries often have health systems with a limited capacity to adapt to and prepare for future climate scenarios. As a result, many of the poorest and most vulnerable countries are likely to bear the brunt of health impacts resulting from climate change and variability. The Intergovernmental Panel on Climate Change identified health as the sector with the greatest potential to reduce the impacts of climate change in many lower- and middle-income countries if adaptation measures are taken. In this paper, we use case studies from a project funded by the United States Agency for International Development (USAID) to examine how to design programmes to reduce climate risks in the health sector. The USAID project called the Adaptation, Thought Leadership, and Assessment (ATLAS) Project and it assisted public health institutions in lower- and middle-income countries. Four specific cases are presented: in Mozambique, supporting the National Institute of Health of to launch a climate and health research observatory; in Ethiopia, working with the Ministry of Health to include climate and weather information into malaria early warning systems; in sub-Saharan Africa, improving our understanding of the relationship between temperature and malaria to inform malaria elimination interventions; and working across all project countries (globally) to manage extreme heat to reduce impacts on human health and well-being. We analyze these four ATLAS Project case examples to identify lessons and opportunities for future decisions and investment in climate and health care system management and capacity building programmes. Key policy insights A user-driven participatory approach improves capacity-building efforts, especially around research for decision making. Identifying and attempting to overcome institutional barriers to work across the health and climate sectors is necessary early in the project design phase for cross-sectoral collaboration. Customized data analytics, such as climate forecasting and epidemiological surveillance, should be tailored to specific health risks. While work at the climate and health nexus is relatively new, there is an increasing number of programmes addressing this linkage. There is an opportunity to increase peer learning opportunities drawing on growing experience across countries.

Unveiling research training gaps in oncology: Evaluating a research capacity-building effort among Nigerian physicians.

Cancers are a disease of growing public health importance in Africa, but cancer research capacity in the region is underdeveloped. The quest to foster and promote locally conceptualized and conducted oncology research in Africa have informed the African Research Group for Oncology's (ARGO) research capacity-building efforts in Nigeria. To evaluate the effectiveness of oncology research capacity-building initiatives among Nigerian senior trainees and junior faculty physicians. Panel study design was employed to study Nigerian senior trainees and junior faculty physicians who participated in two research capacity-building symposia. Data were collected pre-and immediate post-symposia, and 3-month post-first symposium. Changes in knowledge were assessed using the Chi-square test and confidence levels using the Wilcoxon signed rank test. A P value of <0.05 was considered statistically significant. : In the first symposium, the participants' pass rate in the knowledge-based questions improved from 9.8% to 46.7% to 81.5% at the baseline, immediate post-symposium, and 3-month post-symposium, respectively (P < 0.001). Likewise, the participants' confidence level in carrying out certain research-related activities increased after the second symposium (P < 0.001). The study concludes that building capacity for oncology research in low- and middle-income countries is possible with focused symposia and educational programs.

Skills Capacity Building For Health Care Services and Research Through the Sickle Pan African Research Consortium.

Skills development, the building of human capacity, is key to any sustainable capacity building effort, however, such undertakings require adaptable and tailored strategies. The Sickle Pan-African Research Consortium (SPARCo) is building capacity in sickle cell disease (SCD) management and research in sub-Saharan Africa, including a multi-national SCD patient registry, this is underpinned by skills development activities in data, research, and SCD management. Method: The SPARCo Skills Working Group was set up with the mandate of coordinating skills development activities across the three SPARCo sites in Ghana, Nigeria and Tanzania. To tailor activities to the requirements of the consortium, a needs assessment was conducted at the start of the project which identified skills required for SCD management and research and catalogued existing external and internal training programmes. The needs assessment highlighted differences in skill levels between the sites and different organisational structures which required tailored skills development activities at individual, site and consortium levels. Strategy: Based on the needs and the resources available, different types of training activities were implemented: these included online, blended and face to face activities. In order to create a sustainable skills development programme, existing short, medium, long-term, on-job training activities were used wherever possible. World Sickle Cell Day (19th June) was leveraged for training and health education activities. Results: SPARCo has recorded 1,726 participants in skills development activities across the three sites. Skills have been enhanced in data management, SCD and research to underpin the core deliverables of SPARCo. Conclusion and Lessons Learned: The baseline needs assessments and continual review and adjustment were critical for development of an effective skill development strategy for the consortium. This adaptability was particularly valuable during the COVID-19 pandemic. The sustainability plan leveraged existing programmes and activities and has created a pool of people with required skills for health care and research in SCD. To be effective, skills development programmes need to take into account existing capacity, training opportunities and local conditions. The model was applied to SCD and is adaptable to other skills development in healthcare and research in low and middle- income countries.

15. Utilization of Augmented Reality Smart Glasses for the Provision of Remote Surgical Training in the Resource-Constrained Setting

Background: Surgical mission trips constitute an important strategy by which the global surgery campaign addresses inequities in surgical disease worldwide. Travel restrictions related to the COVID-19 pandemic, however, impose a challenging limit on the reach and impact of surgical mission work. In this study, we demonstrate the utility of a remote surgical mentorship program equipped with cutting-edge augmented reality (AR) technology for sustaining global surgery capacity building efforts within the constraints of the COVID-19 pandemic. Methods: Our remote surgical training program connects mentor and mentee surgeons via an AR-enabled digital headset and integrated smartphone application. The Vuzix® Smart Glasses system allows mentee surgeons to transmit a point-of-view livestream of activity in the operating room while receiving direct audio and visual feedback from their remote mentor in realtime. To facilitate their engagement, mentor and mentee surgeons interact using an integrated smartphone application that enables case scheduling, clinical documentation, and performance evaluation. Performance is assessed on the basis of three validated assessment tools that are well-established in the surgical education literature: the Objective Structured Assessment of Technical Skills, the Self-Confidence Scale, and the Student Evaluation of Educational Quality Survey. This survey is administered via the mobile application to both mentor and mentee surgeons at the time of their onboarding as well as after every subsequent three-month training quarter for the duration of the year-long program. Results: To date, 83 mentor and mentee surgeons across 33 countries and 6 continents are enrolled and actively participating in our remote training program. Baseline survey data suggest a mentee surgeon cohort that stands to benefit greatly from inclusion in our training program. A majority of mentee surgeons report incomplete knowledge and anxiety in association with their specialty prior to initiating training. Conclusion: The COVID-19 pandemic has created an urgent need for sustainable remote surgical capacity building strategies. Our remote surgical training program powered by AR-enabled telecommunication and smartphone technology constitutes a promising solution towards this end.

Community participation in disaster management in Gondoriyo village administration, Ngaliyan sub-district, Semarang city

Indonesia as a disaster-prone country demands the active role of the community in disaster management. So, the perspective that focuses on handling during and after a developing disaster must be changed. In this matter, the government establishes the Desa Tangguh Bencana (Destana)/Disaster Resilient Village Policy. With various activities with the community involvement, the risk and impact of disasters can be eliminated because the community has been trained to prepare for disasters. The research aimed at determining the types and forms of community participation in disaster management in Gondoriyo Village Administration, Ngaliyan Sub-District, Semarang City. Gondoriyo Disaster Resilient Village is one of the pioneers in Semarang City, which started from the volunteers of the Disaster Preparedness Group. The research results show that the type of community participation is direct; either in a kind of money, support or their involvement in decision making. Their participation is in the form of thoughts, energy, skills, and property as well. It indicates that the awareness of Gondoriyo community to actively participate in prevention, preparedness, disaster risk reduction and capacity building efforts for the post-disaster recovery. It is proven later that Gondoriyo Village Administration has received the title as the Intermediate Disaster Resilient Village. However, what must be improved is how the disaster management programs are integrated into village administration development plans; particularly in relation to assistance to increase capacity and funding as well. Therefore, its existence can be maintained and sustainable.

Capacity building as the cornerstone of the climate change regime: evolution of the agenda through a policy-practitioner view from Brazil

ABSTRACT As developing economies walk a tightrope balancing economic development with environmental protection, capacity building becomes the most prominent instrument to ensure that the development needs of citizens are met within the realities of the climate change regime. Capacity building sits at the very foundation of the climate change regime, together with ‘finance’ and ‘technology development and transfer’ mechanisms. Recognizing that developing countries are on the receiving end of implementation projects, this review highlights historical understanding of the constituents of capacity building initiatives and how these can advance humanity towards the global good of decelerating, and even reversing, the adverse impacts of climate change. In particular, the article describes the institutionalization of capacity building since the establishment of the international climate change regime and highlights some of the stances of the Brazilian environmental diplomacy in this process. Furthermore, it emphasizes initiatives taken by developing countries to empower their citizens and to serve as a mainstay for enhancing South–South cooperation by sharing climate-friendly practices and capabilities. With the establishment of the Paris Committee on Capacity Building and Capacity Building Initiative for Transparency at COP21, it is clear that ‘clarity’ and ‘tracking of progress’ are the new objective tools needed to build on and supplement NDCs and related national efforts for tackling climate change. Key policy insights Capacity development projects should be tailored to the characteristics and needs of each recipient Non-Annex I country. Effective and lasting development of capabilities requires going beyond imparting technical know-how of environmentally-beneficial technologies and must include adopting a ‘learning by doing’ approach. National institutions of the recipient countries should be at the helm of capacity building projects to bring in necessary knowledge on national regulations, traditional skills, and resources that are vital to the success of these initiatives. Transparency in information flow and timely multistakeholder assessment of capacity building efforts are the lynchpin for enduring capacity development efforts.

Experiences and challenges in accessing hospitalization in a government-funded health insurance scheme: Evidence from early implementation of Pradhan Mantri Jan Aarogya Yojana (PM-JAY) in India.

Government-sponsored health insurance schemes can play an important role in improving the reach of healthcare services. Launched in 2018 in India, Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world's largest government-sponsored health insurance schemes. The objective of this study is to understand beneficiaries' experience of availing healthcare services at the empaneled hospitals in PM-JAY. This study examines the responsiveness of PM-JAY by measuring the prompt attention in service delivery, and access to information by the beneficiaries; financial burden experienced by the beneficiaries; and beneficiary's satisfaction with the experience of hospitalization under PMJAY and its determinants. The study was conducted during March-August 2019. Data were obtained through a survey conducted with 200 PM-JAY beneficiaries (or their caregivers) in the Indian states of Gujarat and Madhya Pradesh. The study population comprised of patients who received healthcare services at 14 study hospitals in April 2019. Prompt attention was measured in the form of a) effectiveness of helpdesk, and b) time taken at different stages of hospitalization and discharge events. Access to information by the beneficiaries was measured using the frequency and purpose of text messages and phone calls from the scheme authorities to the beneficiaries. The financial burden was measured in terms of the incidence and magnitude of out-of-pocket payments made by the beneficiaries separate from the cashless payment provided to hospitals by PMJAY. Beneficiaries' satisfaction was measured on a five-point Likert scale. Socio-economically weaker sections of the society are availing healthcare services under PM-JAY. In Gujarat, the majority of the beneficiaries were made aware of the scheme by the government official channels. In Madhya Pradesh, the majority of the beneficiaries got to know about the scheme from informal sources. For most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, hospitals in Gujarat performed significantly better than the hospitals in Madhya Pradesh. Similarly, for most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, public hospitals performed significantly better than private hospitals. Incidence and magnitude of out-of-pocket payments were significantly higher in Madhya Pradesh as compared to Gujarat, and in private hospitals as compared to the public hospitals. There is a need to focus on Information, Education, and Communication (IEC) activities for PM-JAY, especially in Madhya Pradesh. Capacity-building efforts need to be prioritized for private hospitals as compared to public hospitals, and for Madhya Pradesh as compared to Gujarat. There is a need to focus on enhancing the responsiveness of the scheme, and timely exchange of information with beneficiaries. There is also an urgent need for measures aimed at reducing the out-of-pocket payments made by the beneficiaries.

“Staka Woman Tumas”: An Examination of Police Perspectives on Gender-Balancing within the Royal Solomon Islands Police Force

In countries emerging out of conflict, state-building initiatives tend to prioritize gender-balancing. Post-conflict police reform in the Solomon Islands aligned with this set standard, as capacity-building efforts within the Royal Solomon Islands Police Force (RSIPF) prioritized the empowerment, inclusion, and promotion of women within the force. Through the use of Interpretative Phenomenological Analysis (IPA) this study investigated, identified, and described common perceptions held by eighteen (18) officers about how they viewed gender reform in the RSIPF. The research found that although officers believed that gender-balancing was necessary, the increased inclusion of women conflicted with their traditional roles and positions and brought several challenges to the effective functioning of the force. It was also revealed that officers were of the view that the organization was not yet ready to fully embrace gender-balancing. The arguments presented herein further build on scholarly discussions about gender equality in policing organizations in small-island developing states in the Pacific.

57 Understanding the Burden of Burn Injury in Latin America &amp; the Caribbean

IntroductionBurn injuries are a global health problem disproportionately affecting low- and middle-income countries, especially in Latin America and Caribbean (LAC) where cooking methods, dangerous work conditions, and minimal housing regulations place people at increased risk of burn injury. Until recently, there was limited global epidemiological data on burn injuries. Following publication of the 2017 Global Burden of Disease (GBD17) database, we obtained objective and comparable data on burn injuries while specifically focusing on LAC countries.MethodsData from all 35 LAC countries were collected from GBD17 for fire, heat, and hot substance-related injuries to calculate burn incidence, deaths, and Disability-Adjusted Life Years (DALYs) with respect to country, age, and gender from 1990 to 2017. Incidence and deaths were reported as rates per 100,000 persons. Mortality rate was reported as a percentage of deaths-to-incidence. DALYs were reported in years per 100,000 persons. Incidence, death, DALY, and mortality rate trends were assessed using age-standardized, age-stratified, and gender-specific cohorts. All statistical analyses were performed using Excel.ResultsOver 27 years, LAC’s rates for burn incidence (-19%), deaths (-63%), DALYs (-62%), and mortality (-54%) all decreased with the greatest improvements seen in Brazil and Paraguay. All indicators improved around 15% more than the global averages during the same period with LAC’s rates 30-40% below global rates by 2017. The highest burn incidence (227 cases/100,000) was in Southern Latin America (Argentina, Chile, Uruguay). The Caribbean had the worst DALYs (124 years/100,000). In 2017, LAC accounted for 7% of global burns, 5.5% of deaths, and 5.1% of DALYs with Central America contributing the greatest numbers. For 27 years, Chile had the highest burn incidence but Haiti had the greatest death, DALY, and mortality rates of all LAC. Children under 14 years of age and males were disproportionately affected compared to other regional and global cohorts.ConclusionsDespite a relatively greater reduction in burn severity and lifelong disability within LAC compared to the world, certain regions and countries exhibited significantly higher rates of burn injury, morbidity, and mortality. Central America (e.g. Costa Rica, Belize, Mexico) and the Caribbean (e.g. Haiti, Cuba) were particularly affected, comprising the majority of cases, deaths, and DALYs. This study provides essential analyses for developing regional and country-specific strategies to reduce the burden of burns through targeted interventions for prevention, workforce, and capacity building efforts.

Implications of existing capacity building efforts for the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction: A case study of Japan

Capacity building and the transfer of marine technology (CB&TT) are key parts of negotiations at Intergovernmental Conferences on an international legally binding instrument regarding the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction (BBNJ). Throughout the negotiations, divergent views persisted among governments. One possible reason for such a situation is the lack of comprehensive understanding of existing CB&TT efforts. In this case study, we assessed how these existing efforts could contribute to capacity building for the effective implementation of a newly proposed BBNJ agreement. A review of CB&TT projects implemented by Japanese organizations showed that there was a significant amount of efforts relevant to BBNJ (157 cases between 2010 and 2020, which cost about USD 4.3 billion in total). We also found that many of them provided platforms that could be applied to CB&TT for BBNJ. However, projects specifically tailored for BBNJ were still limited. Furthermore, there were several lessons from existing efforts that could provide useful insights for future initiatives. Given a higher priority of many countries to coastal areas and the exclusive economic zone, new capacity building should focus on not only areas beyond national jurisdiction, but also the other areas to manage the ocean as a whole. Lastly, recommendations are advanced to the UN member states on discussing how to build future initiatives of CB&TT upon existing efforts.

Implementation of Evidence-Based Disease Self-Management Programs in a Rural Region: Leveraging and Linking Community and Health Care System Assets.

Rural populations experience both a higher prevalence of and risk for premature death from chronic conditions than do their urban counterparts. Yet barriers to implement community-based chronic disease self-management programs persist. The Living Well program, a multi-sector collaboration between a rural health care system and a network of community-based organizations, has offered the 6-week evidence-based Chronic Disease Self-Management and Diabetes Self-Management workshops since 2017. The program was a response to a quality improvement initiative to improve hypertension and diabetes outcomes throughout the health care system. Using the rapid cycling quality improvement process, Living Well developed a self-management program recruitment, referral, and coordinating office for a six-county region. Through continuous capacity-building efforts with community partners, as well as leveraging key health care system assets such as the electronic health record and provider detailing, program reach and adoption was increased. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used for the process evaluation. During 3 years, more than 750 individuals engaged with the program, with nearly 600 completing a workshop. The region saw increased engagement by primary care clinicians to refer, and structural changes were embedded into the health care system to facilitate clinic-community partnerships. A coordinated, multi-sector approach is necessary to develop solutions to complex, chronic health problems. A regional coordinating hub is an effective strategy for implementing community-based programs in rural areas. However, low health care system engagement and fragmented funding remain as barriers to optimal implementation.

Capacity Building Efforts for Rabies Diagnosis in Resource-Limited Countries in Sub-Saharan Africa: A Case Report of the Central Veterinary Laboratory in Benin (Parakou).

Rabies has been listed as a priority zoonotic disease in many African countries and the countdown to reach the goal of eliminating dog-mediated human rabies deaths by 2030 means that disease control measures need to be applied fast. In this context, an essential pillar of any national plan to control rabies is the implementation of reliable diagnostic techniques to ensure the success of field surveillance systems. Although many African countries have received international support for the control of rabies–some countries, like Benin, have not received a similar level of support. Indeed, until 2018, Benin was not able to diagnose rabies and rabies diagnosis in animals as well as humans relied solely on observed clinical symptoms. Although the Central Veterinary Laboratory (CVL) of Parakou had the equipment to implement two recommended tests, the lack of specific reagents and skills prevented the implementation of a rabies diagnostic service. Here we present the joint efforts of the national authorities in Benin, intergovernmental agencies, and non-governmental organizations to assess the strengths and weaknesses of the government's rabies control efforts. We have applied the Stepwise Approach toward Rabies Elimination (SARE) analysis, implemented rabies diagnostic capacities at the CVL of Parakou, characterized strains of rabies virus circulating in Benin, and finally integrated an inter-laboratory comparison program.

Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India

BackgroundGovernment-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation.MethodsGuidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019.ResultsAverage turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background.ConclusionsThere is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review.

Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review. With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process. Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries. Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.

OPEN EDUCATIONAL RESOURCES IN THE CONTEXT OF OPEN ACCESS

Objective. This exploratory literature review seeks to identify both emergent consensus areas and research gaps in recent scholarly literature on Open Educational Resources (OERs). Despite the perception of OERs as universally available, these involve persistent barriers. The presence of institutional policies, adequate incentives and support frameworks for the use and sharing of OERs as well as raising awareness about their availability is likely to be critical for their successful deployment. Methods. This study made use of the case study method to arrive at its conclusions. As part of this, secondary data were collected from relevant article searches conducted in Google Scholar and at the Harvard Open Access Tagging Project website. Only papers published in the last five years, e.g., in the years 2016-2021, were taken into consideration. Given that this study has applied the methodology of qualitative comparison and case study construction, this limits the validity of its conclusions to the settings from which the original primary findings were obtained or for which OER recommendations were produced. Results. As part of this research, 16 scholarly articles and research reports were identified as being of relevance for this study. The research questions this study has sought to answer are as follows: How OERs have developed in recent years? What was the impact of the pandemic period on OER use? What are the key barriers for OER deployment? What are the facilitating factors for OER implementation at libraries, colleges and universities? What are the effects of OERs? Conclusions. Recent reports indicate that the pandemic period has both increased the awareness of OERs among education institutions and provided an impetus for capacity building efforts in this domain. Yet, OER effectiveness continues to be under-researched, despite a tentative consensus in scholarly literature concerning the critical role for OER efficacy of institutional support and collaboration frameworks.

Care For Small Babies: A DOH Policy-in-waiting

Care For Small Babies: A DOH Policy-in-waiting