Development Committee Research Articles

Handling client financial insolvency in maternity services: An occurrence, experience and policy gap qualitative analysis among healthcare stakeholders in North-Central Nigeria.

To assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services. A qualitative study was conducted in North-Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility-heads, program managers and policy makers at local and state government levels through In-depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package. Participants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker-related (staff scavenging for needed consumables, fund-raising among facility staff), facility-related (revolving fund, medical social welfare, welfare committee, discharge with re-payment plan, fee-waiver), community-related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post-discharge re-payment agreements. Participants suggested a client-friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale-up of health insurance for pregnant women to curb financial insolvency. Tackling client financial insolvency requires policy documents, support to private facilities, effective debt-recovery mechanisms, and scale up of health insurance for pregnant women.

Public information dissemination and its impact on force account implementation in Kalambo district council, Tanzania

The study assessed dissemination of public information and its impact on implementation of force accounts in Kalambo District Council in Tanzania. A cross-sectional design was employed in collecting data at one point in time with a mixed methods research approach which was used in an attempt to gain detailed information. A total of 145 participants which includes ward development committees, construction committees and community members were involved whereby 46 key informants were selected purposely based on their positions while simple random sampling technique was used in selecting 99 respondents from the community. The survey, interview, focus group discussion and documentary review method were used to gather both quantitative and qualitative data. Quantitative data were analysed using descriptive statistical analysis whereas qualitative data were analysed using content analysis. The study findings revealed that information is not easily accessible to the public and a few shared information is not clear due to confidentiality and technical language. The findings also indicate that the public is unaware about the progress force account due to ineffective dissemination of information which leads to untimely completion of works and misuse of resources. The study concludes that there is inadequate information in the implementation of force account projects, thus resulting in poor support, acceleration of low value for money and lack of accountability due to poor public scrutiny. The study recommends that the government institutions should emphasise the use of authorised social and religious gathering in an attempt to raise awareness. Moreover, the selected committee must engage the public in decision making in order to improve transparency in implementation of projects.

Digitized Mathematics Module: Its Acceptability and Influence on Students’ Motivation and Performance

With the shift to online learning or distance education programs, higher education, in particular, has to focus on ways to cater with the demand of its clientele. Thus, Jose Rizal Memorial State University-Katipunan Campus developed a Digitized Mathematics Module to adapt with the changing landscape of education. However, it is imperative to determine if the module is effective. Thus, the study aimed to determine the acceptability of students towards the digitized Mathematics module and its influence on their motivation and performance of the Mathematics in the Modern World course. Utilizing a descriptive-correlational design, and stratified technique, the study employed one hundred seventy- two (172) students enrolled in Mathematics in the Modern World classes during the first semester of academic year 2020-2021 as respondents of the study. Two sets of questionnaires, adopted from Rio (2014) and Keller (2010), were used as instruments to yield the necessary data for the study. Frequency count, percentage, mean, chi-square, and Somer’s D were the main statistical tools used. Based on the results, the Digitized Mathematics Module is acceptable. The study also revealed that the acceptability of digitized Mathematics module, level of students’ motivation, and students’ Mathematics performance have no significant relationship. As the students accepted the digitized module, they also claimed that they were motivated. Though the module is accepted at a certain level, it is still recommended that the mathematics module needs to be improved so that its acceptability level turns into very acceptable. Instructional Materials and Development Committee (IMDC) may intensify quality assurance in preparing the module to improve its acceptability and motivation levels. The researcher is also proposing to conduct an online seminar workshop serving as an intervention to increase the acceptability of the digitized Mathematics module.

Development Committee: The Managing Director's Written Statement

Development Committee: The Managing Director's Written Statement

Participatory Monitoring and Evaluation and Sustainability of Community Development Projects in Kitui West Constituency, Kenya

There are significant challenges faced by project managers in Kitui west constituency when it comes to implementing sustainable projects, in particular, the Community Level Infrastructure Development Program was aimed at promoting equitable development across the entire constituency through implementing small scale infrastructure projects. However, there was a partial or no realization of the envisaged benefits. The aim of this study was therefore be to assess the impact on sustainability for Community Development Projects in Kitui West Constituency, Kenya from Participatory Monitoring and Evaluation. The study was based on theory of sustainability, the ladder of participation, stakeholder theory, modern organizational theory and real assessment theory. Research was conducted using a descriptive design for this study. 10 projects that have been operational within 2016 - 2021 was the target population of this study. The researcher targeted 87 respondents comprising of 20 project management committee and 67 constituency development committee members. The study conducted a census of 87 respondents. The study sample size was 10 projects with 87 respondents. For the purpose of collecting data in this study, a questionnaire was used. The study tested the instruments in Kitui central constituency involving 8 respondents. Research instruments were assessed for content, face, and criterion validity. Reliability was measured using Cronbach’s alpha. Data analysis involved descriptive statistics (mean, standard deviation) and inferential statistics (correlation, regression). Results, shown in tables and figures, indicated that community engagement, capacity building, resource use, and communication positively impacted project sustainability. The study concludes that involving community members in project planning, implementation, and evaluation fosters ownership and empowerment. The study recommends that the constituency should involve community members in the planning and decision-making processes is crucial which can be achieved through community meetings, workshops, and focus group discussions where residents can voice their needs, priorities, and ideas.

156 Recognition Matters: Increasing Community and Wellbeing Through a Faculty Development Committee

156 Recognition Matters: Increasing Community and Wellbeing Through a Faculty Development Committee

Examining the roles and relationships of actors in community health systems in Nigeria through the lens of the expanded health systems framework

BackgroundCommunity health system (CHS) exists through the actions and activities of different actors within and outside communities. However, these actors, their roles and their relationships with one another have not...

Determinants of access to rural financing in the democratic republic of Congo: The case of Kongo central

This article aims to identify the determinants influencing access to rural finance, focusing on a sample of 500 family farms in Kongo Central. This study revealed that membership in a financial solidarity group and awareness of the existence of a local development committee significantly influences access to credit using Probit and Logit regression methods. This study highlights the importance of supply and demand factors in accessing rural finance. Key demand-related determinants include gender, marital status, sector of activity, household size and high levels of education. This research suggests strengthening policies aimed at increasing financial education and women's empowerment to improve access to financing. These measures could enable more individuals especially women to effectively access and use financial services. By addressing these determinants can help policymakers better design interventions to support rural development in this province. The results underscore the need for a holistic approach considering both supply and demand factors to improve financial inclusion for rural populations.

Ward Development Committees as 4th Level Governance of Primary Health Care in Nigeria: The Rivers State Model

Ward Development Committees as 4th Level Governance of Primary Health Care in Nigeria: The Rivers State Model

Career development committees: A guide for early- and mid-career faculty.

Career development committees: A guide for early- and mid-career faculty.

EMPOWERING WARD CITIZEN FORUMS FOR LOCAL SOCIAL TRANSFORMATION IN NEPAL

The Local Governance and Community Development Program (LGCD) has been found to be adopted a transformational approach to social mobilization, aiming to address the absence of elected political representatives at the community level. Central to this approach has been identified as the Community Ward Citizen Forum (WCF) and the Awareness Centre (CAC), which play crucial roles in enhancing local governance through community engagement.The WCF has been explored to serve as a collective of community representatives’ tasks with bridging the gap between the community and local decision-making processes, thereby improving local governance. Complementing this, it has been focused that the CAC operates on a REFLECT process basis, bringing together marginalized and vulnerable community members weekly to discuss pertinent issues affecting their lives. Through facilitated discussions, participants have been found to identify key issues, devise actionable plans to address these concerns, and establish links with local service providers and Village Development Committees (VDCs) to mobilize necessary resources.Numerous studies and evaluations have been found to have highlighted the effectiveness of WCFs and CACs in initiating community transformation. The research has aimed to underscore the significance of community-based organizations in driving social transformation. It has been known that it provides an analytical overview of the initial successes achieved by WCFs and CACs in fostering social change, explores strategies to expand these successes across broader contexts, and identifies essential prerequisites for the sustained success of the transformational approach to social mobilization. It has been identified that Empowering Ward Citizen Forums (WCFs) for local social transformation involves various approaches aimed at enhancing community participation, decision-making, and overall impact. They have been presented pointwise as the findings of the research. the different approaches have been explored like capacity building, inclusive participation, access to information, collaborative partnerships, supportive policy environment, monitoring and evaluation, sustainable community projects, civic education and awareness, conflict resolution mechanisms, and celebrating successes and learning from challenges have been explored as the best approaches for the empowering the ward citizen forums.It has also been found that Empowering Ward Citizen Forums (WCFs) for local social transformation involves a strategic and inclusive approach that engages community members in meaningful ways. The strategies like establishing clear objectives, inclusive participation, capacity building, access to information, supportive environment, partnerships and collaboration, community-driven initiatives, policy advocacy, monitoring and evaluation, communication and outreach and celebrating successes have been found to be employed. By implementing these strategies, WCFs can effectively empower local communities, drive social transformation, and create positive changes that enhance quality of life and well-being for residents. Each step contributes to building a resilient and engaged community that works together towards common goals and shared aspirations.

Imbalanced specialty representation of USMLE and NBME test writers

PurposeThe United States Medical Licensing Examination (USMLE) is an examination series required for allopathic physician licensure in the United States (US). USMLE content is created and maintained by the National Board of Medical Examinations (NBME). The specialty composition of the USMLE and NBME taskforce members involved in the creation of examination content is currently unknown.MethodsUsing the 2021 USMLE and 2021 NBME Committees and Task Forces documents, we determined each member’s board-certified primary specialty and involvement in test material development committees who we dubbed “test writers”. Total active physicians by primary specialty were recorded from the 2020 Physician Specialty Data Report published by the Association of American Medical Colleges (AAMC). Descriptive statistics and chi-square analysis were used to analyze the cohorts.ResultsThe USMLE and NBME test writer primary specialty composition was found to be significantly different compared to the US active physician population (USMLE χ2[32] = 172, p < .001 and NBME χ2[32] = 200, p < .001). Only nineteen specialties were represented within USMLE test writers, with three specialties being proportionally represented. Two specialties were represented within NBME test writers. Obstetrics and Gynecology physicians were proportionally represented in USMLE but not within NBME test writers. Internal Medicine (IM) accounts for the largest percentage of all USMLE test writers (60/197, 30%) with an excess representation of 31 individuals.ConclusionsThere is an imbalance in the specialty representation of USMLE and NBME test writers compared to the US active physician population. These findings may have implications for the unbiased and accurate portrayal of topics in such national examinations; thus, future investigation is warranted.

Appraising Agriculture Development Strategy of Nepal from Agricultural Extension Perspective

Nepalese economy is primarily dependent on agriculture which provides employment to the vast majority (&gt;60.02%) of the people. The goal of the Agriculture Development Strategy (ADS) is to make agriculture sector more productive, equitable, and sustainable driver for upgrading Nepalese economy. This library based paper thus aims to appraise ADS from extension perspective which is essential for educating farmers about new ideas and information related to agriculture development. The study thoroughly appraises ADS programs, policy documents, scholarly articles and secondary data fact supplemented to the research issue educating and supporting farmers. The result of the appraisal show that implementation of a voucher system and the decentralized strategy of establishing Service Centers for Community Agriculture Extension in each Village Development Committee, use of ICT and GESI based approaches are praiseworthy. However, there are still major obstacles to overcome resource constraints, implementation hurdles, and unclear roles due to the federal governance transition. The paper concludes that to enhance betterment of the ADS, there is a need for increased funding, capacity building, and improved infrastructure. Additionally, stronger monitoring and evaluation systems, along with promoting public-private partnerships and ensuring active farmer participation are essential. Addressing these issues is crucial for achieving goals and objectives of the ADS.

Addressing the Evidence Gap in Aneurysmal Subarachnoid Hemorrhage: The Need for a Pragmatic Randomized Trial Platform.

Aneurysmal subarachnoid hemorrhage (aSAH) occurs less often than other stroke types but affects younger patients, imposing a disproportionately high burden of long-term disability. Although management advances have improved outcomes over time, relatively few aSAH treatments have been tested in randomized clinical trials (RCTs). One lesson learned from COVID-19 is that trial platforms can facilitate the efficient execution of multicenter RCTs even in complex diseases during challenging conditions. An aSAH trial platform with standardized eligibility criteria, randomization procedures, and end point definitions would enable the study of multiple targeted interventions in a perpetual manner, with treatments entering and leaving the platform based on predefined decision algorithms. An umbrella institutional review board protocol and clinical trial agreement would allow individual arms to be efficiently added as amendments rather than stand-alone protocols. Standardized case report forms using the National Institutes of Health/National Institute of Neurological Disorders and Stroke common data elements and general protocol standardization across arms would create synergies for data management and monitoring. A Bayesian analysis framework would emphasize frequent interim looks to enable early termination of trial arms for futility, common controls, borrowing of information across arms, and adaptive designs. A protocol development committee would assist investigators and encourage pragmatic designs to maximize generalizability, reduce site burden, and execute trials efficiently and cost-effectively. Despite decades of steady clinical progress in the management of aSAH, poor patient outcomes remain common, and despite the increasing availability of RCT data in other fields, it remains difficult to perform RCTs to guide more effective care for aSAH. The development of a platform for pragmatic RCTs in aSAH would help close the evidence gap between aSAH and other stroke types and improve outcomes for this important disease with its disproportionate public health burden.

Joseph William Bhore (1878-1960): The Architect Behind the Bhore Committee Legacy.

Sir Joseph William Bhore was a civil official from India. He pioneered the health survey and development committee, known as the Bhore Committee, which set the direction for India's public health facilities and investments. The chairmanship of the Health Survey and Development Committee, which the British colonial administration formed in 1943, is arguably the most well-known role Bhore has held. The committee was founded in 1943 and produced a thorough report in 1946. The committee's suggestions shaped India's health policy and planning and the course of the country's health care growth.

Enhancing Access Through Language-Tailored Approach in Telehealth and Veterans Video Connect: Traumatic Brain Injury (TBI) Veterans Satisfaction Assessment.

Traumatic brain injury (TBI) can impact language processing, necessitating language-tailored approaches. Telehealth may expand rural Veterans' access but has unknown feasibility for language preferences. This study explored telehealth/Veterans Video Connect satisfaction for Spanish/English TBI screening. The study was approved by the VA Caribbean Healthcare System Institutional Review Board and the Research and Development Committee. Mixed methods evaluated telehealth satisfaction in Veterans receiving TBI assessments from October 2021 to October 2023. Surveys included the 16-item Clinical Video Telehealth (CVT) questionnaire on communication, technical factors, coordination, and overall satisfaction, and the 21-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) examining usefulness, ease of use, manners, quality, and satisfaction. Mean domain/item scores were calculated among 57 Veterans, 12 English, and 45 Spanish-speaking. Semi-structured interviews also elicited user experiences from 4 providers and 5 Veterans. Transcripts underwent qualitative coding for themes using Atlas.ti.8. On CVT (0-5 scale), overall satisfaction averaged 4.50 (English) and 4.69 (Spanish). Lowest scoring item for English users was easy video connection (4.25), while unclear expectations had the lowest Spanish score (3.60). For TSUQ, overall mean scores were 4.50 (English) and 4.67 (Spanish), with improved health post-telehealth having the lowest average (English 3.33, Spanish 3.67). Qualitatively, Veterans and providers noted strengths like access and communication but weaknesses around connectivity, care delays, and privacy. Differences emerged regarding convenience (Veterans) versus operational barriers (providers). There was a strong positive correlation for Spanish surveys and a moderate correlation for English surveys (r = 0.71 Spanish surveys, r = 0.69 English surveys) between TSUQ and CVT for individual respondents. Patients conveyed positive experiences, but qualitative data revealed actionable targets for optimization like infrastructure and coordination improvements. Key limitations include small samples and lack of comparison to in-person care. Still, high satisfaction coupled with specific user feedback highlights telehealth's potential while directing enhancements. The results found high Veteran satisfaction with Spanish/English TBI telehealth, but mixed methods illuminated salient domains for better accommodating user needs, particularly regarding logistics and technology. Rigorously integrating experiences with metrics over expanded diverse samples and modalities can further guide refinements to enhance telehealth with a language-tailored approach.

Expert consensus on clinical application of inhaled nitric oxide therapy (2024 edition)

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that has been used in newborns, children, and adults with various cardiopulmonary diseases to reduce pulmonary artery pressure and improve oxygenation. Currently, there are numerous brands of iNO devices on the market with significant differences in performance, as well as variations in connection and setup. Additionally, adverse reactions such as methemoglobinemia may occur during iNO treatment. Therefore, the safety and efficacy of this treatment need to be ensured in clinical practice. To address these concerns and standardize the clinical application of iNO therapy, the Respiratory Care Group of Chinese Thoracic Society and Respiratory Therapist Working Group of Respiratory Career Development Committee, Chinese Association of Chest Physician have organized relevant experts to develop an expert consensus on the clinical application of iNO therapy based on the latest research progress and clinical operational experience. This consensus includes 11 expert consensus recommendations on indications and contraindications of iNO, selection and connection of iNO devices, dose selection and therapeutic effect evaluation of iNO, adverse effects and occupational protection during iNO treatment, transport of patients with iNO, weaning of iNO, cleaning, disinfection and maintenance of iNO devices, and iNO clinical use process and records. The aim is to improve the cognitive and practical ability of clinical practitioners for the standardized application of iNO therapy, so as to ensure the safety and effectiveness of clinical application of iNO therapy.

Information and Communication Technology Usage in School Management: A Case of Selected Hwange District Schools in Matabeleland North Province, Zimbabwe

Apart from the fundamental function of teaching and learning, schools also ensure the realisation of the institutions' aims and vision. This is possible through use of Information and Communication Technology (ICT) which has been identified as an essential global phenomenon for efficient and effective schools. Hence, the purpose of this study was to examine usage of ICT in school management in Hwange District. A qualitative approach driven by the interpretivism paradigm was adopted. A case study design focusing on selected schools was employed. Thematically analysed data were collected through semi-structured interviews and document analysis. Findings indicated that the selected school heads mainly used ICT platforms such as WhatsApp, emails and printed documents for communication. Parents, through School Development Committee, provided internet connectivity for easy communication while the school heads used their personal smart phones. The study found that school heads faced various hurdles in using ICT in their management duties. These challenges included lack of resources, inadequate knowledge and skills to use ICT tools, work overload, inadequate funds to acquire ICT hardware and software equipment, lack of appropriate ICT infrastructure, limited internet access and sporadic power supplies. Despite the difficulties encountered, the study concluded that there were visible pockets of good practices in the use of ICT by selected school heads. The study recommended that the Ministry of Primary and Secondary Education should capacitate school heads through ICT training. This will result in efficiency and effectiveness of school heads in execution of their management functions.

A Roadmap for Training in Urogynecology: IUGA International Initiative.

Training in urogynecology is an important mission of the International Urogynecological Association (IUGA). Promoting official training programs in countries around the world is an integral part of this mission. The IUGA established the Fellowship Development Committee to develop a roadmap to assist countries to develop a professional training program in urogynecology. Two focus groups were created: the curricula topics focus group and the survey focus group. The curricula topics focus group is aimed at developing a list of subjects that can be the basis for a training syllabus. The survey focus group is aimed at understanding the main steps and the difficulties in establishing an official training program by interviewing representatives from both accredited and non-accredited countries and developing a roadmap for an official training program recognized by the local authorities. The fellowship development committee included 13 members. The curricula topics focus group developed a format for the description of each included topic. Each topic had to include a description of the required related skills and procedures. Two curricula topics lists were created: one for basic training and a second for advanced training. The survey focus group conducted two table discussions with representatives from countries with accredited training programs and countries without accredited training programs. The comments of these meetings were summarized in documents submitted to the IUGA board of directors. The fellowship development committee studied the main hurdles to developing an official training program in urogynecology. The roadmap document should form the basis of the IUGA international initiative to assist countries around the world to develop an official training program in urogynecology recognized by the local authority.

이원화 자치경찰제 추진을 위한 선결 과제

The autonomous police system is based on the premise that the quality of life of the residents can be improved by the police system for the residents, by the residents, and for the residents. Fundamental questions have been raised as to whether Korea's autonomous police system is being operated for the residents, but on the other hand, the current autonomous police system has been implemented after discussion and review of the autonomous police system for a considerable period of time. The autonomous police system is a system that pursues values contrary to the national police system, placing importance on democracy and procedurality rather than efficiency. The autonomous police system is an essential element in the decision-making process of residents aiming for grassroots democracy, and Korea's autonomous police system does not utilize the purpose of the autonomous police system in that it is implemented by determining the model and operation method centrally. In order to operate the autonomous police system, a blueprint to transfer much of the police power to local governments should have been presented, but due to the inefficiency of decentralized systems, confrontation between the two Koreas, and familiarity with the implementation of the national police system, a centralized national police system was maintained, and a formal police organization with limited responsibilities and authority was established in local governments and only some police duties closely related to residents' lives was carried out as an office manager. Despite various problems, the autonomous police system has become an irreversible trend of the times, and although it is insufficient, discussions continue as it contributes to improving the quality of life of residents by improving the problems. The Yoon Suk Yeol government, which was launched in May 2022, launched the “Police System Development Committee” under the Prime Minister in September of the same year and said that it would pilot the dual autonomous police system in Jeju, Sejong, Gangwon and Jeonbuk, but discussions were underway until February 2023 and have been suspended. Given that time is needed to overhaul legislation, implement new models, and improve complementary points, it is not easy to keep its pledge to fully implement the dual autonomous police system by 2026. There are both negative criticisms of the autonomous police system, which has been implemented from 2021 to 2024, as well as positive evaluations of the process of developing the autonomous police system as a transitional period. It is difficult to say that the “double-level” model, in which autonomous police organizations are operated separately from national police, immediately carries out practical autonomous police administration, but it can take on the shape of an autonomous police rather than a unified model. A form of incorporating the national police system centered on the autonomous police system was considered a hard landing plan, and a form of incorporating the autonomous police system centered on the national police system was suggested as a soft landing plan. As a hard landing plan, the full transfer of national police authority to local governments and the introduction of an election system for the chairman of the municipal and provincial autonomous police committees or police officers were proposed. As a soft landing plan, a bill should be enacted or revised to allow the dualization model to operate more efficiently, which should include organizational and operational aspects. The main contents will require the transfer of organization, manpower, and budget to local governments, and accordingly, organizations that can perform autonomous police affairs, such as the autonomous police committee and the autonomous police headquarters, should be reorganized.