Implementation Gap Research Articles

Climate crisis and human migration: the emergent sociolegal parameters of a science-based policymaking

IntroductionThe Paris Agreement, signed in 2015, is the epitome of the effort for a global consensus on the problem of climate change and its repercussions, including climate-induced migration, aimed at improving the institutional capacity for the formulation of effective adaptation and mitigation policies. One of its novel characteristics was the incorporation of science in the formal policy toolkit: States must use the best available science, as the empiricism of traditional policy-making regimes, bequeathed by an era of ordinary climatic patterns, must now take a backseat and give way to the emerging paradigm of science-based policymaking. Given the growing awareness of the climate migration problem affecting humans from all paths of life and likely to disrupt social cohesion and economic development, our era is set to become an epoch of climate migration; still, the rights of climate displaced peoples continue to be neglected.MethodsThis article examines the extent to which the Paris Agreement and associated public policies have the capacity to address climate induced migration, since international law urges States to address all critical impacts of climate change, using the best available scientific knowledge in this purpose. The analysis is based on a review of the existing literature on the science-policy interface, followed by a presentation of developing trends in international law. Subsequently, the authors attempt to present the socio-legal context of the emerging trends and assess the integration of science in climate migration policymaking. In this context, comparative case studies are presented to underscore what seems to be disparities and gaps in policy implementation in this area.ResultsOur findings show that climate change raises unforeseen challenges that have not been properly assessed by policy makers both at the international and national levels, such as the extent of climate-induced human displacement and migration and the urgent necessity for legal protection of climate-induced migrants. The lack of a concrete and legally binding framework for States is highlighted, while science is only incorporated at suboptimal levels, although there seem to be recent changes in this paradigm, suggesting a shift towards greater operational integration of scientific inputs.DiscussionThe study highlights the prospects and challenges of emerging policy contexts, especially the binding duty to use science for policymaking, resulting in specific obligations –i.e., the necessity to produce and disseminate data, and to create the necessary institutional arrangements–, given that existing policy measures remain inadequate in addressing the scale and urgency of climate induced migration. The incorporation of science in policy, although progressing, requires more robust implementation to support climate justice initiatives, that must be pursued despite the complex policy implications involved at all levels.ConclusionThe paper suggests that efforts must be intensified in this specific direction to efficiently support initiatives toward more social and environmental justice, such as encouraging the development of climate migration databases and establishing specialized bodies. Parallel to this, it is suggested that enhancing the role of scientific evidence in policymaking should go hand in hand with strengthening the international legal frameworks; both will be essential to ensure that climate-displaced populations are adequately protected and supported.

Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis.

The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Bridging the implementation gap for climate mitigation in ASEAN: a comprehensive capacity-building framework

PurposeThe paper systematically examines the capacity building needs of energy and climate stakeholders in the Association of Southeast Asian Nations (ASEAN). It looks at conditions and opportunities for improvements in institutional, organisational, technological, innovation and financing capacities. This paper provides a guide to concrete capacity building programs and implementations to accelerate the implementation of National Determined Contributions (NDCs) and low-carbon energy transition in the ASEAN region.Design/methodology/approachThis paper proposes a comprehensive capacity-building framework, drawing on transition management theory and the interactive systems framework for capacity building. The assessment is based on interviews with representatives of the ministry responsible for energy policy and the ministry responsible for climate policy in each ASEAN country, as well as a survey among a broader set of Southeast Asian energy and climate experts from academia, think tanks and international development partners.FindingsThe paper identifies the priority areas for capacity building for each ASEAN country and the region as a whole. Each country has a unique set of needs and priorities. At the regional level, the widest capacity gaps were observed in institutional capacity, technical capacity, human resources capacity, financing capacity and the capacity to develop policy and legislation. Specific gaps for capacity building are discussed in delivering strategic areas of energy transition, such as electrification of transportation, development of the green supply chain, deploying renewable energy, energy efficiency, strengthening finance and investment and reducing dependencies on fossil fuels.Originality/valueThis paper helps fill the gap for detailed capacity needs analysis and facilitates long-term plans/strategies and their implementation. The insights help to increase ASEAN energy and climate stakeholders’ understanding of the interaction between energy and climate, therefore enhanced capability in developing more effective action maps and intervention points in achieving NDCs and sustainable development goals.

AN EVALUATION OF THE EFFECTIVENESS OF THE PROVISION OF LAND USE POLICY FOR BUILDING HOUSES IN RURAL BANGLADESH

The paper provides a comprehensive evaluation of the national land use policy in Bangladesh, highlighting the gaps in implementation and the need for strategic improvements for building houses using minimum agricultural land in rural areas of Bangladesh. The main objectives of the policy evaluation research are to explore the extent of the intervention of the National Land Use Policy 2001 that has achieved the objective of minimum use of agricultural land, to determine whether the authority has made the rural people aware of building model houses, multistorey buildings, and planned residential areas in the village and finally to find out the critical factors for effective implementation of national land use policy. It has been used as a mixed evaluation research method with both qualitative and quantitative approaches. Data were collected online using a semistructured questionnaire and checklist for respondent interviews. The main results of the policy evaluation revealed that the objectives of the policy are not achieved and effectively implemented for numerous reasons as such, the implementers are reluctant to implement and make aware the villagers, responsible implementing agencies are not fully well-defined, people are unaware and do not know about the policy, lack of village development planning and design, overpopulation and segregation of families, poverty, lack of monitoring by the ministry, unorganized urbanization and industrialization, local political influence, absence of land zoning and union parishad are unwilling to enforce their laws, etc. To implement the policy effectively, a joint effort of the local government bodies, local communities, and all local administration departments would be required, and each organization’s role would be well classified, and payment or loan support would be transferred to the rural people of Bangladesh.

Implementation gaps in cross-border co-operation: evidence from the regional train network in Greater Geneva

ABSTRACT The Léman Express (LEx) is Europe’s largest cross-border rail network. As the backbone of public transportation that connects Geneva with its French suburbs, the LEx should contribute to increasing sustainable mobility and to achieving the 2050 carbon neutrality objective. Accompanying measures such as new bus routes and tramways connected to LEx stations as well as bicycle lines, park and ride, and pedestrian facilities should be implemented to ensure that LEx achieves its full impact on the modal shift and active mobility. However, the findings in this study demonstrate that more than half of the LEx’s accompanying measures are overdue; planning quality, national co-funding, and municipal support are key factors for reducing delays in their implementation. Notably, these empirical findings hold across the Greater Geneva area despite the institutional peculiarities of the Swiss and French political and administrative systems. This case study adds to the literature regarding European border studies by analysing the consequences of a cross-border environment on territorially bounded projects.

Theories of change: navigating diverse expert perceptions and preferences for global food system transformation

IntroductionEfforts are underway to transform food systems in light of their contributions to global challenges like climate change. However, food systems are highly complex, involve noteworthy place-based challenges, and there is often debate and disagreement among experts over appropriate technologies or interventions to prioritize. Tracking progress, and understanding these differences, is thus a critical need.MethodsWe surveyed food systems experts in eight countries about their preferences for 20 different food system transformation strategies and their sentiment regarding whether current initiatives are sufficient to meet 2030 goals for climate and biodiversity.ResultsExpert sentiment is overwhelmingly negative, and experts are concerned about multiple “transformation gaps,” including gaps in ambition, strategy, and implementation. Expert rankings for 20 strategies vary notably among countries and in ways that do not match those same experts’ rankings for the strength of the science behind each lever. Factor analysis reveals four distinct theories of change informing experts’ subjective biases: transformation via technical optimization, via smallholder support, via nature-positive solutions, and via supply chain enabling conditions.DiscussionThese findings provide insights for navigating the complexities of food system transformation and illustrate the influence on our strategies of preconceptions and biases in how we have come to understand the nature of the challenge.

The Pan-African Surgical Healthcare Forum: An African qualitative consensus propagating continental national surgical healthcare policies and plans.

Access to equitable, safe, affordable, timely, and quality surgical healthcare in Africa remains limited. Few African countries have surgical healthcare plans or policies. Where these exist, there are significant gaps in dissemination, funding, and implementation. A Pan-African Surgical Healthcare Forum (PASHeF) was initiated to address this. The inaugural forum was a two-day consensus conference of technocrats from African Ministries of Health hosted by the Honorable Minister for Health of Rwanda in Kigali. Through coordinated discussions, plenary sessions, working groups, and technocrat networking, they charted the path forward for national surgical healthcare policies and plans. Discussions were sparked by country experiences, and working groups focused on curated context-specific, face-validated questions. Documentation involved field notes, audio recordings, and artificial intelligence transcription. Data was coded using a constant comparative method to itemize delegates' observations, declarations, and recommendations, with member checking. A consensus statement was generated using an inclusive decision-making model. Thirty-two Ministries of Health were represented by 42 delegates who drafted and unanimously adopted the PASHeF 2023 Consensus Statement. This was a 50-point consensus addressing country commitment, leadership, financing, stakeholder mobilization, monitoring and evaluation, partnerships, and other aspects of national surgical healthcare planning in Africa. This consensus is the African roadmap and emphasizes implementation, the need for flexibility in policy development, and current opportunities and barriers. It emphasizes that community involvement and sustainability should undergird this planning, in addition to a focus on the entire spectrum of surgical healthcare, including prevention and rehabilitation. Delegates endorsed PASHeF as an annual event with a secretariat and recommended the creation of a Pan-African Surgical Healthcare Policy monitoring system, and that issues of surgical healthcare should be escalated as an agenda item on African Union and sub-regional ministerial meetings. African nations have embraced surgical healthcare policy as an imperative on their journey towards Universal Health Coverage.

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

New development: The implementation (gap) of senior civil service recruitment reform—a matter of organizational size?

New development: The implementation (gap) of senior civil service recruitment reform—a matter of organizational size?

Comprehensive Survey of Image Steganography Systems based on FPGA Implementation

Steganography is the art of concealed communication. The basic idea of steganography is to hide secret data inside a cover media in an undetectable manner. Cover media and Secret data can be any popular digital media such as image, video, audio, or text. Various types of image steganography methods have been proposed according to the cover image domain, i.e. spatial domain and transform domain. The spatial domain methods are easy and simple while the transform domain methods are more complex. However, the transform domain methods are more robust against image processing operations. Besides, they are more secure and less detectable in an unsecured channel. The recent steganography methods are based on sophisticated algorithms that include several computational time-consuming tasks, and hence they are unable to embed and extract the hidden data in real-time. Therefore, the trend is to implement the steganography methods in the hardware to speed up their processing time and so improves the efficacy of steganography techniques. FPGA is used in various fields in the modern era due to lower development cost, flexibility, and reconfigurability. Most of the published steganography techniques carried out on FPGA are based on the spatial domain. In this paper, it has comprehensively studied and reviewed various existing implementations of image steganography on FPGAs. This includes studying their general operations, requirements, and performance evaluations. This review would assist researchers in finding the research gaps in FPGA implementation of steganography methods for real-time applications.

Can smart cities improve energy resilience? Evidence from 229 cities in China

Energy security is a crucial component of national economic stability and growth. Given current technological limitations, improving management strategies is essential for safeguarding energy resources. Digital technologies play a pivotal role in enhancing management efficiency, thus contributing to energy security. As a key element of modernization, smart cities leverage digital solutions to drive urban development and have the potential to catalyze an energy revolution. Nevertheless, the relationship between energy security and smart cities remains underexplored, creating gaps in policy-making and implementation. This study, leveraging the smart city pilot policies enacted in 2012, 2013, and 2015, utilizes a sample of 229 prefecture-level cities covering the period from 2010 to 2020. Employing the Propensity Score Matched Difference-in-Differences (PSM-DID) model, the research assesses smart city policies’ impact on energy resilience. The results show that smart city policies significantly enhance energy resilience through three separate pathways: optimizing resource allocation, upgrading industrial structure, and promoting technological progress. Notably, smart city polices have more beneficial effects on the city characterized by low fiscal expenditure, being populous, resource-based, having high human capital, and being located in eastern region. This study aids in the improvement and promotion of smart city policies, thereby enhancing energy resilience and achieving sustainable urban development.

Preference of mHealth versus in-person treatment for depression and post-traumatic stress disorder in Kenya: demographic and clinical characteristics

ObjectivesWe conducted an implementation science mental health treatment study in western Kenya, testing strategies for scale up of evidence-based mental health services for common adult disorders using a non-specialist workforce, integrated with existing primary care (Sequential Multiple, Assignment Randomized Trial of non-specialist-delivered psychotherapy (Interpersonal Psychotherapy) and/or medication (fluoxetine) for major depression and post-traumatic stress disorder (PTSD) (SMART DAPPER)). Because study launch coincided with the COVID-19 pandemic, participants were allowed to attend treatment visits via mHealth (audio-only mobile phone) or in-person. We conducted a secondary data analysis of the parent study to evaluate preference for mHealth or in-person treatment among our study participants, including rationale for choosing in-person or mHealth treatment modality, and comparison of baseline demographic and clinical characteristics.Design, setting, participants and interventionsParticipants were public sector primary care patients at Kisumu County Hospital in western Kenya with major depression and/or PTSD and were individually randomised to non-specialist delivery of evidence-based psychotherapy or medication (n=2162).OutcomesTreatment modality preference and rationale were ascertained before randomised assignment to treatment arm (psychotherapy or medication). The parent SMART DAPPER study baseline assessment included core demographic (age, gender, relationship status, income, clinic transport time and cost) and clinical data (eg, depression and PTSD symptoms, trauma exposures, medical comorbidities and history of mental healthcare). Given that this evaluation of mHealth treatment preference sought to identify the demographic and clinical characteristics of participants who chose in-person or mHealth treatment modality, we included most SMART DAPPER core measurement domains (not all subcategories).Results649 (30.3%) SMART DAPPER participants preferred treatment via mHealth, rather than in person. The most cited rationales for choosing mHealth were affordability (18.5%) (eg, no transportation cost) and convenience (12.9%). On multivariate analysis, compared with those who preferred in-person treatment, participants who chose mHealth were younger and had higher constraints on receiving in-person treatment, including transport time 1.004 (1.00, 1.007) and finances 0.757 (0.612, 0.936). Higher PTSD symptoms 0.527 (0.395, 0.702) and higher disability 0.741 (0.559, 0.982) were associated with preference for in-person treatment.ConclusionsTo our knowledge, this is the first study of public sector mental healthcare delivered by non-specialists via mHealth for major depression and/or PTSD in Sub-Saharan Africa. Our finding that mHealth treatment is preferred by approximately one-third of participants, particularly younger individuals with barriers to in-person care, may inform future mHealth research to (1) address knowledge gaps in mental health service implementation and (2) improve mental healthcare access to evidence-based treatment.Trial registration numberNCT03466346.

Trauma-Informed Care in Undergraduate Nursing Education: An Integrative Review.

Trauma-informed care (TIC) requires health care providers and organizations to provide care in a way that assumes everyone has a trauma history (Hopper et al.). Although there has been a recent rise to investigate TIC within various nursing specialties, knowledge related to integrating TIC into nursing curricula remains unclear. An integrative review following Whittemore and Knafl procedures synthesized the literature related to TIC in undergraduate nursing education. Five themes surfaced: (1) isolated tic integration in undergraduate courses; (2) TIC for safe learning environments; (3) inconsistent TIC definitions in nursing education; (4) prerequisite nurse educator training; and (5) students recognizing an implementation gap and seeking solutions. This review highlights TIC integration challenges in nursing education, emphasizing the need for ongoing research, training, and collaboration. These efforts are vital to equip future nursing professionals with the skills to provide high-quality trauma-informed care, benefiting students, patients, and health care delivery. [J Nurs Educ. 2024;63(11):737-745.].

Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021-2023.

Despite theincreasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya. We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14-55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP. Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19-24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15-19 years more often reported never taking PrEP compared with those 25-36 years (aPR 1.31, 95% CI: 1.06-1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04-0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60-0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02-1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03-2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40-0.92). We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.

World Health Organization Guidance on Health Practitioner Regulation: An Overview

ABSTRACT: The World Health Organization has released its first comprehensive Guidance document on health practitioner regulation, addressing a critical gap in global health policy. This Commentary provides an overview of the Guidance, which aims to support countries in strengthening their regulatory systems for health practitioners. The Guidance, developed through a rigorous process involving a literature review and expert consultation, covers a broad range of health practitioners and focuses on optimizing their utilization to meet population health needs. Key highlights include the description of the global regulatory landscape, identification of regulatory challenges in all societies, and policy considerations to realize dynamic, effective, and agile regulation. The COVID-19 pandemic is cited as an important example of a catalyst for regulatory reforms that enhanced workforce availability and access. This paper, co-authored by members of the World Health Organization Technical Expert Group, emphasizes the importance of aligning regulatory systems with broader health workforce and system priorities, adopting a risk-based approach, and addressing implementation gaps. It encourages policymakers, regulators, and researchers to use the Guidance to assess and update their regulatory systems and to generate more robust evidence on the impact of health practitioner regulation on health outcomes.

Gendered vulnerabilities in climate shocks: the role of social protection interventions

Abstract This review explores how climate change exacerbates gender inequalities and the potential of social protection programs to alleviate these impacts. It examines how women disproportionately bear the brunt of climate shocks and discusses pathways through which programs like public works initiatives, cash transfers, and social insurance can bolster women's resilience in this framework. Despite the potential of these programs, challenges such as implementation gaps and limited engagement of women in program design hinder the effectiveness of social protection programs. Limited research on the gendered effects of social insurance underscores the need for further investigation and gender-responsive policy interventions.

Comprehensive sexuality education: indicators to evaluate interventions in Italian schools

Abstract Background Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation. Methods The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation. Results A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation. Conclusions Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy. Key messages • The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation. • By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.

Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome

Abstract Introduction After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce the risk of recurrence. Moreover, despite 2016/2019 ESC/EAS guidance on lipid management according to risk, several studies indicate that most patients do not attain low-density lipoprotein-cholesterol (LDL-C) goals. The present study aims to describe LLT prescription patterns after a non-fatal acute coronary syndrome (ACS) and identify opportunities for improvement in secondary preventive measures, namely LDL-C control. Methods Retrospective cohort study featuring adults aged 40-80 residing in a Portuguese municipality Portugal, using Electronic Health Records between 2016 and 2022. Selected patients had ≥1 general practice appointment three years before the occurrence of an ACS, which was considered an index date. Sub-analysis was made based on patients’ age (under and high or equal to 65 years), gender, and whether their LDL-C levels were controlled according to gradual upper thresholds of 100 mg/dL in the period before the ACS event and 55 mg/dL at one-year post-ACS. Results Among the 544 selected patients, 270 were younger than 65 years. Females comprised 30% (164 patients) of the total cohort, 27% of the under-65 group, and nearly 38% of the 65 and older group. In younger patients, LDL-C levels were higher at presentation (132 mg/dL) and had a significantly greater decrease during the follow-up period compared to the older group. In the period before the ACS, 71.1% of men and 56.7% of women had no previous prescription of LLT, and younger patients had worse levels of LDL-C control (24.1%) compared to older patients (46.0%). One year post-ACS, the pattern of LLT revealed a substantial drop in patients without any LLT prescription from 66.7% to 13.6% and an increase in high-intensity LLT from 2.4% to 16.5%. Still, moderate-intensity LLT (66%) remained the most frequently used LLT. An increase in LLT potency was observed in the follow-up, although there was a decrease in patients achieving LDL-C control. Previous to the ACS event, 35.3% of men and 34.8% of women had initially controlled LDL-C levels according to defined thresholds, which significantly reduced to 11.3% and 8.5%, respectively, at one-year post-ACS. Conclusion Despite initiating or intensifying LLT after ACS, LDL-C goals were not achieved in approximately 9 out of 10 patients at 1-year follow-up, highlighting that the LLT adjustment was insufficient. Therefore, there is a need for better optimisation of LLT after ACS, unveiling an alarming gap in guideline implementation in clinical practice.

Beyond Design: Examining the Implementation of Gender-Responsive Social Protection in Ethiopia

Recent years have witnessed increased global attention and investment in inclusive and gender-responsive social protection programming in low- and middle-income countries. While high-level design commitments are important and welcome, in practice, they may not guarantee protection from vulnerabilities and a reduction in gender inequality. Programme implementation presents a critical, yet often underestimated, challenge. This article offers insights into the reality of implementing the gender provisions of Ethiopia’s Productive Safety Net Programme. Drawing on qualitative data from rural Ethiopia, it shows that the implementation of the gender provisions has generated implementation gaps and inconsistencies. The findings highlight the need to move beyond commitments on paper and allocate greater resources and attention to the implementation of gender-responsive social protection.

Deliberation on continuous spread of corruption in South Africa

Corruption is widely spread in South Africa and is against the norms of honestly, morals, values, ethics, and good governance. The reasons of corruption may be individual (personal greed for luxury, power, authority), organisational (inadequate monitoring and evaluation, reporting processes), legislative (no compliance), strategic (lack of ethical culture), to state a few. The study is aimed to find answers to the following guiding research question, such as: what is the extent of corruption in South Africa? The qualitative study utilised secondary sources through the literature review of articles and document review of annual/official reports to gather relevant information. The information was further assessed using document analysis. The findings show that corruption is spreading at every level of government, and even public and private sectors are getting exposed to cases of misconduct. The country has established various legislative frameworks to combat corruption. The objectives of anti-corruption frameworks are operationalised through the establishment of anti-corruption organistaions. Some of them are Corruption Watch; National Anti-Corruption Advisory Council; Financial Intelligence Centre; Organisation Undoing Tax Abuse; and National Anti-Corruption Hotline. The findings show that although there are anti-corruption measures in place, the inadequate compliance may create implementation gaps, hence corruption keeps on spreading at political level, bureaucratic offices, and even in municipalities. The study suggests policy measures to minimise the scope and spread of corruption.