Global Health Programs Research Articles

Research on the reasons and ways that successful entrepreneurs benefit society

Successful entrepreneurs such as Warren Buffett and Jack Ma have built thriving businesses and donated a portion of their earnings to charitable organizations that promote education, health care, and the environment. This paper first theoretically explores how successful business people benefit society by making and spending money. Then, this paper takes Chinese listed companies that have generated positive accounting profits in the past three years as samples to explore the relationship between environmental investment and intangible assets of listed companies and empirically verifies whether CEOs increase CSR investment out of strategic motives. Regression results show that when environmental investment increases by 1%, intangible assets of listed companies increase by 0.053%, indicating that CEOs may benefit others strategically to maximize the wealth of stakeholders and increase profits. Therefore, this paper finally draws the conclusion that successful business people not only make a positive contribution to society but also benefit the whole society. They fulfill their social responsibility by supporting global health, development, and sustainability programs, and the modern economy is critical to incentivizing this philanthropy.

Key competencies for global health research: systematic literature review and mapping

Abstract Background Despite a boom in global health programmes and trainings, there is a lack of clarity and standardisation about which competencies are essential for researchers in global health, who stem from diverse disciplines and backgrounds. The objective was to map key competencies for global health research and approaches to progressively develop them in education and training. Methods We performed a systematic review in English in PubMed/MEDLINE, Web of Science, and Psychinfo/EBCSO host of literature published since 1 January 2010. 1827 articles were screened in duplicate. Data was extracted from 84 publications about focus in global health, recommended competencies and educational approaches, with two researchers giving a relevancy rating. AI-assisted extraction was conducted on 40 high-relevance publications to garner further information, informing development and application of a coding framework to these articles. Results Emerging results point to eight main domains and numerous subdomains related to competencies seen as critical for global health research. In addition to traditionally emphasised cognitive competencies (e.g. methodological), the literature underlined the importance of critical analyse of how systems related to globalisation, political economy and structural injustice shape health at local level. Also highlighted was the need for more focus on affective and practical competencies for conducting global health research in alignment with equity principles, including through innovative pedagogical approaches. Conclusions Our review identifies competencies seen as essential for global health researchers, including skills to critically analyse geopolitical, colonial and structural drivers, as well as self-reflexivity, (cultural) humility and other key affective competencies. It also highlights, however, the significant diversity of perspectives, lack of consensus, and ongoing disconnect between principles and practice. Key messages • Greater clarity and consensus is needed around the specific competencies required to work as a researcher in global health, taking account of diversity across disciplines, sectors and stages. • Global health researchers require skills to critically analyse geopolitical, colonial and structural drivers, as well as self-reflexivity, (cultural) humility and other key affective competencies.

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Building bridges: enhancing cultural understanding and community engagement in the CHAMPS program—experience sought from Gobe Challa Village, Ethiopia

Public health programs’ successful implementation often requires a thorough consideration ⁠ of local cultural contexts and effective community engagement. The complexities and obstacles that public health initiatives may face in culturally ⁠ diverse communities are highlighted by our case study, offering valuable insights. ‍ This article focuses on analyzing a particular incident that occurred in Gobe Challa Village, connected ⁠ to the implementation of the Child Health and Mortality Prevention Surveillance (CHAMPS) program. In Gobe Challa Village, an incident occurred that centered on discord within the community and religious fears, resulting ⁠ from misunderstandings surrounding and a general lack of comprehension about the CHAMPS program. Our resolution process involved engaging the community, and religious leaders in constructive dialogue. Throughout this involvement, we delivered extensive elucidation on the aims and ⁠ protocols of the CHAMPS program, mitigating conflicts within the community. The community successfully achieved acceptance of the CHAMPS program by directly ⁠ and respectfully addressing misconceptions and fears, fostering a common understanding. This study emphasizes the significance of effective communication, community engagement, and ⁠ consideration of cultural customs when implementing public health programs. The experiences derived from this incident can act as a practical ⁠ manual for future public health initiatives encountering analogous cultural and societal dynamics. The main emphasis is on highlighting how a proactive, sensitive, and inclusive approach can ⁠ alleviate potential conflicts while also promoting program acceptance and encouraging community engagement. These discoveries have relevance to various public health initiatives and emphasize the significance ⁠ of a culturally conscious, community-involved approach in executing global health programs. ‍

The Glass Ceiling in Global Health: Perspectives of Female and Male Anesthesiologists.

Gender equity is essential for improving health outcomes globally. Despite comprising 75% of the global health workforce and dominating academic global health programs, women remain underrepresented in leadership positions in global health organizations. Our study aimed to identify potential gender differences in the beliefs and attitudes regarding barriers that women anesthesiologists encounter in pursuing careers and leadership roles in global health and to identify recommendations for improving gender equity in global health. We conducted a cross-sectional online survey focusing on career leadership opportunities and challenges uniquely faced by women clinicians in global health. We obtained permission from the World Federation of Societies of Anaesthesiologists to distribute our questionnaire to their leadership committee members during 2 months (May-July 2022). The questionnaire was distributed to 164 study participants with 67 individuals (44.8% female) based in 38 different countries completing the survey (response rate 40.9%). Overall, 47.8% of the participants aspired to a leadership position in global health and 58.2% agreed women face unique barriers to global health leadership (70.0% of women compared to 48.6% of men; P = .081). Female gender (odds ratio [OR], 19.22, P = .004) and divorced marital status (OR, 746.26, P = .004) were positively associated and African ethnicity (OR, 0.002, P = .017) was negatively associated with the perception of gender bias in their career growth. The main challenges included balancing work and family responsibilities, lack of female mentors or role models, gender-based discrimination, and limited opportunities for career advancement. Men acknowledged these challenges but reported personally experiencing them to a lesser extent, particularly concerning lack of opportunities (P = .005), inadequate pay (P = .000), and lack of training (P = .000). Gender disparities exist in the pursuit of global health careers. This study underscored that more women than men perceive barriers in pursuing leadership roles in global health and that men generally encounter these obstacles to a lesser extent. Female representation in leadership positions could be supported through evidence-informed policies that promote work-life balance, improve mentorship, offer equal opportunities for career advancement and adequate pay, and combat gender-based discrimination.

Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review.

There is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings. We nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact). 152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated. This review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs.

INDONESIA’S EFFORT TO MEET WHO RECOMMENDATION ON EXCLUSIVE BREASTFEEDING 2012-2023

Background: The World Health Organization (WHO) provides policy recommendations related to exclusive breastfeeding that can be adopted by UN member states. In Indonesia, the government has issued a policy to support exclusive breastfeeding based on WHO recommendations. Objectives: To describe effort in exclusive breastfeeding governance in Indonesia from 2012 to 2023 according to WHO recommendations. Method: This research uses a descriptive qualitative methodology and relies on a literature review from a variety of sources, including books, journals, articles, websites, and more, to gather information about Indonesia's efforts to meet the WHO recommendations about exclusive breastfeeding from 2012 to 2023. Results: It showed that there were efforts in the community due to applied policies, such as the provision of lactation rooms in public facilities, the formation of Breastfeeding Support Groups, the training of breastfeeding counselors, and the establishment of the PelanggaranKode website to continue to support the exclusive breastfeeding program. Conclusion: There are efforts indicating that government policies are not yet optimal. Recommendations for future research should be more specific by exploring strategies for effective advocacy and policy change to support breastfeeding, as well as evaluating the impact of global health initiatives and programs that promote breastfeeding

A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs.

Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examined the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.

Drivers of success in global health outcomes: A content analysis of Exemplar studies.

Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topics in 28 countries. This paper aims to identify findings, summarized as themes and sub-themes, that appear among all completed EGH studies. We developed a conceptual framework and used a content analysis approach to identify the top thematic areas that appear as drivers for programmatic success across EGH studies that were completed between June 2020-May 2023. The EGH studies (N = 31) spanned six topics including under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (CHW) (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and newborn and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Latin America, South and Central Asia, and the Caribbean regions. Top drivers of success were defined as those critical or catalytic in achieving the intended outcome. Eight key drivers were identified: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women's empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting. These cross-cutting drivers span a broad range of development outcomes, sectors, and populations, and indicate a need to effectively integrate people, systems, and sectors to improve global health outcomes. Findings from this study aim to support peer learning among countries and support evidence-based decision-making for funders, policymakers, and other key stakeholders.

Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study.

The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were "contactability of the participants" and "participants' mobile number changes," and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice.

Experiences in global mental health.

Participating in Global Mental Health program development and education and training efforts is rewarding and exciting work. The author describes several global experiences he has engaged in over the past 30 years, which has focused on teaching and encouraging family therapy and mental health care that support human rights and promote human development as innovated and promoted by the Global Alliance for Behavioral Health, formerly the American Orthopsychiatric Association. The author learned through participation that merely presenting mental health information and treatment approaches through lecture presentation was not adequate to help professionals and advocates in low- and middle-income countries to build sustainable mental health care systems in their home regions. The author engaged in several collaborative program development efforts with local professionals at their invitation. These programs, consisting of multiyear partnerships based on the needs and culture of the home region, will be described in the article. The programs, based on relationships between local professionals and a U.S. team of experts in child mental health care, had long-term positive effects and were highly rewarding. The basis for these programs was an invitation by local professionals, followed by collaboration in setting the agenda for the U.S. professionals' visits, an on-going relationship in which local professionals trusted that the visitors want and need to understand the local cultural environment, and improvements that will be most helpful and sustainable. In this process, the author learned about the cultures he worked in and was a part of extremely meaningful and enlightening relationships and experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dynamic Ecosystem Adaptation through Allostasis (DEA-A) Model: Conceptual Presentation of an Integrative Theoretical Framework for Global Health Change.

Achieving ambitious goals in Global Health first requires an integrative understanding of how individuals and organizations adapt in a living ecosystem. The absence of a unified framework limits the consideration of the issues in their complexity, which further complicates the planning of Global Health programs aimed at articulating population-based prevention and individual-level (clinical) interventions. The aim of the conceptual contribution is to propose such a model. It introduces the Dynamic Ecosystem of Adaptation through Allostasis (DEA-A) theoretical framework, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. The DEA-A framework articulates two central components to grasp the complexity of adaptation: the internal dynamics (intrasystem level) and the environmental dynamics (ecosystem level). It bridges diverse conceptual approaches, including stress and adaptation models, behavior-change models, and ecosystem-based perspectives. Epistemological considerations raised in the conceptual article prompt a reconsideration of methods and tools for the planning of intervention. Further contributions will present a suitable methodology for the application of the DEA-A framework along with practical recommendations.

(In)visibilising pregnancy loss in Southern Malawi

Miscarriages, stillbirths and neonatal deaths have received limited attention in global health programmes and research, even though pregnancy loss is common, traumatic and stigmatised. This paper seeks to illuminate lived experiences of pregnancy loss in southern Malawi, drawing on findings from semi-structured interviews and focus groups with women who have experienced loss, health professionals and community members, and observations of maternity care. Combining thematic and discourse analysis, we show how societal and medical discourses frame women as responsible for (failed) reproduction, and restrict possibilities to speak about, and respond to, loss. Some accounts and (care) practices invisibilise loss and associated suffering. However, invisibilisation may also be intended as support, and underscores rather than denies the social significance of parenthood. Other accounts (e.g. women emphasising faith and acceptance) constitute moral survival strategies to avoid the acquisition of a ‘spoiled identity’. We conclude that societal and medical discourses of loss enact stigmatised, subaltern subject positions for women experiencing pregnancy loss, create social suffering, and amount to a form of structural violence. Programmes and interventions should change these discourses.

Planetary health education in the United States: four curricular models, one goal

ABSTRACT Global environmental crises demand scaled-up investment in education about planetary health. We identified college and university programs in the United States that focus on the human-animal-ecosystem nexus by systematically searching the 2023–2024 catalogs of more than 1000 schools. We identified four frequently-used curricular models: (1) One Health programs offered by universities with veterinary and agriculture schools that emphasize zoonotic diseases, antimicrobial resistance, food safety, and wildlife conservation; (2) climate change and health (climate medicine) programs for graduate and professional students at large universities with medical and public health schools; (3) global environmental public health programs focused on pollution and other exposures; and (4) sustainability and health programs emphasizing food security, environmental justice, and other health issues that can be improved with ethical design and engineering. Highlighting the shared goals of these distinct academic models may help make planetary health a more visible area of teaching, research, and practice.

Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems.

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.

Implementation of a Multi-Site Digitally-Enhanced School Clinician Training and ADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE

Childhood conditions of inattention and disruptive behavior, such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), are prevalent but undertreated worldwide. One promising solution is harnessing digital technology to enhance school clinician training and ADHD/ODD intervention programs. We conducted a school-clustered randomized controlled trial of CLS-R-FUERTE: a program featuring training/consultation for school clinicians to deliver a six-week intervention comprised of weekly parent and student skills groups, as well as support teachers’ classroom management in the form of a Daily Report Card, all facilitated by electronic program manuals/materials and videoconferencing. A total of N = 163 (n = 6–8 students/school [ages 6–12] and their parents, teachers, and school clinicians) participated across eight public schools in Sinaloa, Mexico. We randomly assigned four schools to receive CLS-R-FUERTE immediately and four schools to receive school services as usual. We compared groups post-treatment on parent- and teacher-rated ADHD/ODD and impairment. We observed the program implementation in vivo, tracking trainer and school clinician program fidelity, as well as participant attendance and adherence, to evaluate feasibility. We also collected participant ratings of satisfaction and usability on the System Usability Scale to evaluate acceptability. Our CLS-R-FUERTE trial demonstrated high rates of program feasibility and acceptability comparable to prior in-person program trial findings. Students receiving CLS-R-FUERTE showed greater improvement in parent- and teacher-rated ADHD, as well as parent-rated ODD and impairment, compared to students receiving school services as usual. Results support the utility of global digital mental health programs training school clinicians to implement ADHD/ODD interventions, which have the potential to increase evidence-based treatment access and uptake across worldwide contexts.

Contraception Access in Global Health Policies and Programs

Contraception Access in Global Health Policies and Programs

Effect of low-cost kitchen with improved cookstove on birthweight of neonates in Shahjadpur, Bangladesh: a cluster-randomised controlled trial

Smoke from biomass fuels used for cooking in traditional cookstoves contains a variety of health-damaging pollutants. Inhalation of these pollutants by pregnant women has been linked to abnormal foetal development and adverse pregnancy outcomes, including low birthweight (LBW). There is a dearth of data on environmental interventions that have the potential to reduce exposure to biomass fuel during pregnancy and improve birth outcomes. International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) therefore, designed a low-cost kitchen with an improved cookstove and examined the impact of this intervention on the birthweight of neonates. icddr,b conducted a cluster-randomised controlled trial of a 'low-cost kitchen with improved cookstove' intervention among 1,267 pregnant women who used traditional cookstoves in a rural sub-district of Bangladesh. All participants were enrolled during the first trimester of pregnancy among 104 randomly selected clusters after obtaining informed consent. The model kitchens were installed in 628 participants' households of the intervention group, and 639 participants continued to use traditional cookstoves as the control group. The primary outcome was the proportion of LBW neonates between the intervention and control groups. The study also examined if the intervention would reduce CO exposure, measured by the differences in maternal blood carbon monoxide saturation (SpCO) levels and prevalence of LBW in neonates. We performed a generalized structural equation model for jointly assessing the simultaneous relationships of biomass fuel exposure to LBW of neonates and the relationships of LBW of neonates to maternal blood SpCO level. This trial was registered with ClinicalTrials.gov (NCT02923882). We found that in the intervention group using 'low-cost kitchen with improved cookstove', the risk of LBW reduced by 37% (adjusted risk ratio: 0.63, 95% CI [0.45, 0.89]). Between the second and third trimester, the mean maternal blood SpCO level was significantly reduced from 10.4% to 8.9% (p-value <0.01) in the intervention group but remained unchanged in the control group (11.6% and 11.5%). Of the total effects of the intervention on the risk of LBW, 48.3% was mediated through maternal blood SpCO level. The risk of LBW among rural neonates was reduced in the intervention group using 'low-cost kitchen with improved cookstove', which may be attributed to the reduction in maternal blood SpCO level. Additional research is needed to identify other mechanisms through which biomass fuel exposure might lead to adverse pregnancy outcomes. Grand Challenges Canada: Rising Stars in Global Health Programme.

América Primeiro: ajuda externa na administração do Trump

Abstract The US has led the way building the international development cooperation system and been the largest single donor for the last seven decades. Foreign aid has gone through different phases during the post-World War II period and remains an important geopolitical and geo-economic tool for 21st century USA. The Bush and Obama administrations, despite different nuances in terms of discourse and aid practices, invested in reforms to modernise aid programmes, increased funding for USAID, and created new global health, food security, and climate change programmes. Contrary to the historical trend, the Trump administration submitted budget requisitions characterised by a 30% reduction for State Department and USAID allocations. It is noteworthy that the Trump administration questioned the costs of global leadership, criticised international organizations and the sectoral allocation of funds, and made threats of cuts in aid to countries that opposed Washington’s interests. The purpose of this article is to understand how the strategy of ‘America First’ changed the strategic tripod of defence, diplomacy, and development, by analysing changes in US foreign aid in terms of available resources, recipient countries, aid modalities, and multilateral engagement.

Supporting Acute Neonatal and Paediatric Care Quality in Nepal

The RCPCH Global Health programme has been working for over 20 years in many middle- and low-income countries to help improve the quality of child health worldwide. In 2021, RCPCH Global launched a new programme in Nepal working in partnership with Nepal Paediatric Society (NEPAS) the Nepal Ministry of Health and United Nations International Children’s Emergency Fund (UNICEF). This report outlines the component of the programs and highlights the success in improving neonatal and paediatric emergency care.