In-country Partners Research Articles

The current situation of health equity in underserved areas of Afghanistan.

In Afghanistan, providing universal health coverage (UHC) in accordance with the principles of the UHC declaration is challenging on two fronts: the geographic topography of the country and the prevailing gender dynamics within the local culture. We conducted a desk review of underserved areas in the context of health services by gathering and analyzing existing literature, reports, and data using a combination of keywords and phrases such as: "underserved areas," "healthcare disparities," "access to healthcare," and "health services." The primary data were derived from an analysis of underserved populations conducted by the World Health Organization (WHO) Afghanistan's Emergency Program, supplemented by information from in-country partners. In addition to other reports, this review focused on analyzing the geographical availability of primary healthcare (PHC) services by employing the guidelines set forth in the SPHERE framework. It also took into account the social dynamics within the Afghan population that may create barriers to equity in terms of demand and access to PHC services. Although there are a significant number of primary healthcare facilities in operation (4,242), they are unevenly distributed across different regions of Afghanistan, resulting in almost 25% of the population being underserved. The underserved population is nearly equally distributed between genders, with the majority residing in rural communities. Women of childbearing age represent 28% of the underserved population. Children under the age of five represent 16-18% of the underserved population in all regions, except in the western region, where they represent between 12 and 13%. Individuals over 60 years of age represent 1-3% of the underserved population across all regions. More than 50% of the population in the Central Highlands of Afghanistan is underserved, followed by the western and southern regions. Ghor province in the western region has the highest proportion of underserved populations, followed by Zabul province in the southern region. Afghanistan is currently experiencing a protracted humanitarian crisis, with millions of people living in poverty and lacking access to healthcare. This situation exposes them to serious risks such as disease epidemics, starvation, and maternal and child mortality. It is crucial to implement alternative strategies to reach the most affected populations and to increase funding for the delivery of healthcare services in Afghanistan.

Effectiveness of custom seating and mobility services for individuals with disabilities in Guatemala

The purpose of this study was to evaluate the effectiveness of custom seating and mobility services provided via an international service learning (ISL) model on the occupational performance of individuals with disabilities in Guatemala. A one-group prospective pretest-posttest design was implemented using the standardized Wheelchair Outcome Measure (WhOM – Spanish) administered on the day of wheelchair fitting, and at 3- and 6-month intervals after receiving seating and mobility services. A two-tailed t-test demonstrated a statistically significant (p < 0.001) improvement in satisfaction for in-home and out-of-home occupations for all participants (n = 71) at 3-months with a huge effect size (d > 2) and this improvement was maintained at the 6-month interval. The results were consistent for various areas of occupational performance (e.g. activities of daily living). The provision of customized seating and mobility services by occupational therapists through an ISL model demonstrated effectiveness at improving satisfaction with occupational performance for individuals with disabilities in Guatemala. Cultural humility, customization of equipment based on personal and environmental factors, inclusion of education and training, and collaboration with in-country partners were identified as contributors to positive outcomes.

Promoting social, emotional, and cognitive development in early childhood: A protocol for early valuation of a culturally adapted digital tool for supporting optimal childrearing practices.

The Thrive by Five app promotes positive interactions between children and parents, extended family, and trusted community members that support optimal socio-emotional and cognitive development in the early years. This article aims to describe the protocol for a prospective mixed-methods multi-site study evaluating Thrive by Five using surveys, interviews, workshops, audio diaries from citizen ethnographers and app usage data. The study activities and timelines differ by site, with an extensive longitudinal evaluation being conducted at two sites and a basic evaluation being conducted at five sites. The learnings from the more comprehensive evaluations inform the iterative research and development processes while also ensuring ongoing evaluation of usability, acceptability and effectiveness of the app and its content across varying contexts. The study evaluates: (1) the impact of the Thrive by Five content on caregiver knowledge, behaviours, attitudes and confidence; (2) how the content changes relationships at the familial, community and system level; (3) how cultural and contextual factors influence content engagement and effectiveness and (4) the processes that facilitate or disrupt the success of the implementation and dissemination. All in-country partners have been identified and data collection has been completed in Indonesia, Malaysia, Afghanistan, Kyrgyzstan, Uzbekistan, Namibia and Cameroon. Very few digital health solutions have been trialled for usability and effectiveness in diverse cultural contexts. By combining quantitative, qualitative, process and ethnographic methodologies, this innovative study informs the iterative and ongoing optimisation of the cultural and contextual sensitivity of the Thrive by Five content and the processes supporting implementation and dissemination.

Applying design thinking for collaborative strategic planning in global health partnerships: the Operation Smile experience

Background Power asymmetries between global health actors based in low and middle-income countries (LMICs) and those based in High-Income Countries persist. Often actors in low-resource settings are seen solely as implementers of projects designed in High-Income Countries and are often not involved in the decision-making. To tackle the problem of power imbalances, a human-centered framework of design thinking was used for inclusive strategy development. This paper discusses how design thinking was used as a framework for the co-creation of Operation Smile Malawi’s (OSM) long-term strategy in a collaborative environment with in-country and international partners. Methods The strategic planning process included a situation analysis, priority setting workshop and participant feedback. A four-question design thinking framework was used to frame the three-day priority setting sessions; ‘what is’, ‘what if’, ‘what wows’, and ‘what works’. Design thinking tools that were used during the priority setting workshop included; visualization, journey mapping, mind mapping, brainstorming and concept development. At the end of the priority-setting sessions, an e-survey was used to assess the participants’ understanding and perception of the use of design thinking for strategic planning. Results The product of the process was a long-term strategy with goals, activities and strategies that were understood and agreed upon by all stakeholders. The post-workshop e-survey revealed that all participants responded that the design thinking process fostered team spirit during the entire process. The design thinking process also made the strategic planning workshop more productive and enabled participants to incorporate their own ideas into the five-year strategy. Furthermore, participants reported learning something outside their area of expertise. Conclusions As global health organizations increasingly recognize the need for equitable partnerships in the design and implementation of global health programs, the human-centred approach of design thinking can be used to create open and collaborative program design.

Access to essential therapy for sickle cell disease in Africa: Experience from a national program in Ghana

Novartis, a global medicines company, and the Sickle Cell Foundation of Ghana (SCFG), an advocacy organization, have endeavored to support the implementation of global best practices in the care of people living with sickle cell disease (SCD) in Africa, and to address unmet needs relating to this condition on the continent. Beginning in 2019, a multifaceted SCD program was implemented in Ghana through a public-private partnership involving the government of Ghana, the SCFG, Novartis, and other partners. A key component of the program involved expanding the reach of hydroxyurea (HU), the only approved disease-modifying generic treatment for SCD, in ways that would promote sustainable access. The program helped to raise the profile of SCD in Ghana and, in 2022, the government adopted HU into its National Health Insurance Scheme. Features of the effort in Ghana are now being expanded to other countries in Africa through cocreated programs with in-country partners. This article reviews the program's history, progress, challenges, and lessons learned.

Impact of Seating and Mobility Services for Individuals With Disabilities in El Salvador.

Outcomes research on the impact of seating and mobility services delivered using a short-term medical mission (STMM) model is limited. To evaluate the impact of seating and mobility services on the occupational performance of individuals with disabilities in El Salvador. One-group retrospective pretest-posttest. Clinical (El Salvador). Individuals with disabilities in El Salvador. Survey and the standardized Wheelchair Outcome Measure (WhOM) for those who received a wheelchair as their mobility device. Participants rated satisfaction with performance of preferred in-home and out-of-home occupations on the WhOM before and after receiving seating and mobility services. For most survey questions assessing the impact on activities of daily living, more than 86% of the respondents selected agree or strongly agree. Nearly half of the respondents reported that questions regarding work and education were not applicable. Participants' WhOM scores (n = 86) demonstrated a statistically significant improvement in performance satisfaction for both in-home (p < .001; d > 1) and out-of-home (p < .001; d > 1) occupations after they received services, with a huge effect size (d > 2). The findings suggest that seating and mobility services provided by rehabilitation professionals in El Salvador improved occupational performance for people with disabilities. Compared with STMMs that solely provide equipment, the findings emphasize the importance of professional service provision with education and training as best practice. What This Article Adds: Seating and mobility services delivered through a STMM model may improve occupational performance for individuals with disabilities. However, STMMs should be carefully planned in collaboration with in-country partners, provide customized seating systems, and include education and training from licensed rehabilitation professionals.

Strengthening Speed and Child Restraint Enforcement Capacity in the Philippines

Recent legislative developments in the Philippines provided opportunities to strengthen existing speed enforcement capacity and build competence in relation to enforcing child restraint use for the first time in this country. The Global Road Safety Partnership’s (GRSP) Road Policing Capacity Building programme team worked closely with government and non-government agencies in the Philippines to develop and deliver a series of classroom and roadside theoretical and operational training sessions. These training sessions resulted in the establishment of a core group of trainers from within local enforcement agencies in the country. This group received initial training as well as ongoing coaching and mentoring support from GRSP to establish a sustainable model of enforcement capability development. Various training methods and curriculum topics are described, noting the importance of supporting in-country partners to determine relevant, context-specific issues according to local needs in the country. This body of work provides a useful example of mechanisms to transfer specific knowledge from the field of traffic law enforcement to police officers in a systematic way, and to build training and enforcement capacity in a sustainable manner.

Nutrition in City Ecosystems (NICE): Protocol of a multi-sectoral development project to improve food and nutrition security of secondary city populations in Bangladesh, Kenya and Rwanda.

Secondary cities tend to be better linked with local food systems than primate cities, acting as important platforms to trade agricultural produce with rural surrounding. COVID-19, conflicts and climate change continue to expose inefficiencies in food systems and have further exacerbated malnutrition, calling for substantial food systems transformations. However, tackling current food systems' challenges requires new approaches to ensure food and nutrition security. Nutritious and agroecologically produced food offer the potential to transform food systems by improving diets and alleviating pressure on the environment, as well as by creating jobs and reducing poverty. This paper describes the design of a project by a Swiss public-private consortium to improve food and nutrition security and to reduce poverty in city ecosystems in six secondary cities in Bangladesh, Kenya and Rwanda through governance/policy and supply and demand side interventions. The Nutrition in City Ecosystems (NICE) project promotes well-balanced nutrition for city populations through interdisciplinary agricultural, food, and health sector collaborations along city-specific value chains. Adopting a transdiciplinary systems approach, the main interventions of NICE are (i) advocacy and policy dialogue, (ii) building of decentralized institutional capacity in multi-sectoral collaborations, (iii) support of data-driven planning, coordination and resource mobilization, (iv) anchoring of innovations and new approaches in city-level partnerships, (v) capacity building in the agricultural, retail, health and education sectors, as well as (vi) evidence generation from putting policies into practice at the local level. NICE is coordinated by in-country partners and local offices of the Swiss public-private consortium partners. The NICE project seeks to contribute to urban food system resilience and enhanced sustainable nutrition for city populations by (A) strengthening urban governance structures involving key stakeholders including women and youth, (B) generating income for producers along the supply chain, (C) triggering change in producers' and consumers' behavior such that nutritious and agroecologically produced foods are both in demand as well as available and affordable in urban markets, and (D) allowing a scale up of successful approaches to other national and international cities and city networks.

Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019.

acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.

Research Partnerships and Guidance in Academic Global Ophthalmology.

Research Partnerships and Guidance in Academic Global Ophthalmology.

The Cyrenaica Coastal Survey Project: Documenting Endangered Maritime Heritage in Libya

This paper introduces the Cyrenaica Coastal Survey (CCS), a collaborative project between the Maritime Endangered Archaeology project and the Department of Antiquities (DoA) Cyrenaica in partnership with the Universities of Al Bayda and Benghazi in Libya. Since the Arab Spring in 2011 and the subsequent civil unrest in Libya, heritage professionals, the DoA, and various individuals interested in heritage have struggled to safeguard heritage sites across the country, as policies and laws that protected archaeological sites were no longer reinforced and adhered to in the wake of the revolution. This lack of finances, capacity, and governmental support led to an unprecedented loss of archaeological sites since 2011. The CCS survey records the current condition of maritime sites along the Cyrenaican coast. The project focuses on the smaller, lesser known, coastal heritage sites that are not as well studied as the much larger classical period port towns of Apollonia, Tocra, or Ptolemais. This article will focus on the results of the first phase of the project between ancient Phycus (modern Zawiet el-Hamama) and Kainopolis (modern Al-Ogla). The results of the first stage of the Cyrenaica Coastal Survey provides a snapshot of the damages and threats that coastal heritage faces in Libya, most notably (often unregulated) building activities, clearance, sand mining, and coastal erosion. Furthermore, this article highlights the importance of remote collaboration between UK institutions, in-country partners, and heritage authorities, especially in countries where the discipline of maritime archaeology has been established more recently.

Perspectives of frontline health workers on transition from development assistance for health in Ghana: A qualitative study.

Many Low-income countries depend on development assistance for health (DAH) to finance the health sector. The transition of these countries to middle-income status has led to reduction in effective aid from development partners while these countries are expected to graduate from global funding agencies such as Gavi the vaccine alliance, with implications for service delivery. The aim of this study was to explore the perspectives of frontline health workers regarding the implications of Ghana's transition to middle-income status on service delivery, the likely impact and opportunities it presents to the country. This exploratory qualitative study employed in-depth interviews to collect data from 16 health workers at three hospitals in the Greater Accra Region; one at the regional level and two at the district level. The study was conducted from December 2019 to July 2020. Data from interviews were transcribed, coded and analysed using thematic analysis in NVivo Qualitative Analysis Software version 12. The level of awareness among frontline workers about the transition and decline in DAH was generally low. Nonetheless, frontline health workers perceived that the country seems inadequately prepared for transition as donors continue to be major financiers for the sector and even for emergencies such as the current COVID-19 global pandemic. Potential challenges facilities would face due to transition may include difficulty in funding health programs, human resource challenges and delays in logistics and medicines. The implications for these will be poor health outcomes, defective monitoring and evaluation, and lapses in training programs. In addition, the perceived barriers to transition identified were poor management of resources, political interference and lack of technical expertise. While opportunities such as improvement of the health sector prioritization and efficiency, private sector involvement and autonomy could be gained. Gaps in the health intervention monitoring resulting from DAH transition could pose affect health outcomes, particularly in respect of HIV, tuberculosis and malaria. The country's preparedness to transition from DAH could be better improved with development of a clear transition plan agreed by stakeholders, including government and in-country development partners. For the health sector, the eligibility for DAH transition should not simply be based on economic growth, but importantly on a country's ability to sustain ongoing and upcoming health programs.

Nationwide introduction of HPV vaccine in Zimbabwe 2018-2019: Experiences with multiple cohort vaccination delivery.

The World Health Organization (WHO) recommends the human papillomavirus (HPV) vaccine for girls aged 9-14 years for cervical cancer prevention and encourages vaccinating multiple cohorts in the first year to maximize impact. The HPV vaccine was introduced nationwide in Zimbabwe in 2018 through a 1-week school-based campaign to multiple cohorts (all girls 10-14 years old), followed by a single cohort (grade 5 girls in school and age 10 girls out-of-school) in 2019. During the 2019 campaign, the multiple cohort's second dose was concurrently delivered with the single cohort's first dose. We interviewed national-level key informants, reviewed written materials, and observed vaccination sessions to document HPV vaccine introduction in Zimbabwe and identify best practices and challenges. Key informants included focal persons from government health and education ministries, in-country immunization partners, and HPV Vaccine Strategic Advisory Group members. We conducted a desk review of policy/strategy documents, introduction plans, readiness reports, presentations, and implementation tools. Vaccination sessions were observed in three provinces during the 2019 campaign. Key informants (n = 8) identified high cervical cancer burden, political will, vaccine availability, donor financing, and a successful pilot program as factors driving the decision to introduce the HPV vaccine nationally. The school-based delivery strategy was well accepted, with strong collaboration between health and education sectors and high community demand for vaccine identified as key contributors to this success. Challenges with transitioning from a multiple age-based to single grade- and age-based target population as well as funding shortages for operational costs were reported. Zimbabwe's first multiple cohort, school-based HPV vaccination campaign was considered successful-primarily due to strong collaboration between health and education sectors and political commitment; however, challenges vaccinating overlapping cohorts in the 2019 campaign were observed. Integration with existing health and vaccination activities and continued resource mobilization will ensure sustainability of Zimbabwe's HPV vaccination program in the future.

Transitioning a Public Health Study Abroad Program to Virtual Format During the COVID-19 Pandemic: Implications for Public Health Practice

High impact learning practices (HIPs) are practices that promote deep learning through student engagement. They focus on the knowledge, attitudes, and skills college students need to succeed academically and professionally and afford students the opportunity to participate in activities beyond the classroom, resulting in learning and personal development. HIPs take various forms and include study abroad, signature experience, first-year seminars, and learning communities. As part of its HIPs, the Georgia State University (GSU) School of Public Health (SPH) offers students the opportunity to study abroad every summer under the auspices of faculty. However, in the summer of 2021, all GSU SPH study abroad programs, including my program, Field Study of Contemporary and Emerging Public Health Issues in Ghana: A Focus on Water and Sanitation, HIV, and Women’s Health Program, were canceled due to the COVID-19 pandemic. Owing to student continued interest, it was imperative to devise a creative method to ensure that students received a comparable experience despite the pandemic. This paper documents the transitioning of a three-week program to a virtual synchronous format to give students the opportunity to work with and learn from in-country partners in Accra, Ghana. The activities, challenges, and lessons learned from transitioning the program are also shared. Overall, students and in-country partners completed three comparative field studies that explored issues related to water and sanitation, the human immunodeficiency virus (HIV), and women’s reproductive health in Ghana. Students and partners identified and reflected on areas of similarities and differences between Ghana and the United States on the public health issues they focused on in the field. Copyright © 2022 Maiyaki et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Development and assessment of novel virtual COVID-19 trainer-of trainers course implemented by an academic–humanitarian partnership

ABSTRACT Background In response to the coronavirus disease (COVID-19) pandemic, Project HOPE®, an international humanitarian organization, partnered with Brown University to develop and deploy a virtual training-of-trainers (TOT) program to provide practical knowledge to healthcare stakeholders. This study is designed to evaluate this TOT program. Objective The goal of this study is to assess the effectiveness of this educational intervention in enhancing knowledge on COVID-19 concepts and to present relative change in score of each competency domains of the training. Methods The training was created by interdisciplinary faculty from Brown University and delivered virtually. Training included eight COVID-19 specific modules on infection prevention and control, screening and triage, diagnosis and management, stabilization and resuscitation, surge capacity, surveillance, and risk communication and community education. The assessment of knowledge attainment in each of the course competency domain was conducted using 10 question pre-and post-test evaluations. Paired t-test were used to compare interval knowledge scores in the overall cohort and stratified by WHO regions. TOT dissemination data was collected from in-country partners by Project Hope. Results Over the period of 7 months, 4,291 personnel completed the TOT training in 55 countries, including all WHO regions. Pre-test and post-test were completed by 1,198 and 706 primary training participants, respectively. The mean scores on the pre-test and post-test were 68.45% and 81.4%, respectively. The mean change in score was 11.72%, with P value <0.0005. All WHO regions had a statistically significant improvement in their score in post-test. The training was disseminated to 97,809 health workers through local secondary training. Conclusion Innovative educational tools resulted in improvement in knowledge related to the COVID-19 pandemic, significantly increasing the average score on knowledge assessment testing. Academic – humanitarian partnerships can serve to implement and disseminate effective education rapidly across the globe.

Relief, Development, Empowerment Part Three: Looking at the Larger Picture Amidst a Global Pandemic

Relief, Development, Empowerment Part Three: Looking at the Larger Picture Amidst a Global Pandemic

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone.

BackgroundFollowing the West African Ebola virus disease (EVD) outbreak of 2013–2016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting.Methodology/Principal findingsGiven the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo.Conclusions/SignificanceThe EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.

An embedded implementation research initiative to tackle service delivery bottlenecks in the expanded programme on immunisation in Pakistan: Overview and reflections.

BackgroundEmbedded implementation research (IR) can play a critical role in health systems strengthening by tackling systems and implementation bottlenecks of a program. To achieve this aim, with the financial support of GAVI, the Vaccine Alliance, in 2016, the Government of Pakistan, UNICEF and the Alliance for Health Policy and Systems Research (AHPSR) launched an Embedded IR for Immunisation Initiative (the Initiative) to explore health systems and implementation bottlenecks, and potential strategies to tackle such bottlenecks in the Expanded Programme on Immunisation (EPI) in Pakistan. In total, 10 research teams were involved in the Initiative, which was the first of its kind in the country. In this paper, we provided a brief overview of the Initiative’s approach as well as the key learnings including challenges and successes of the research teams which could inform future embedded IR Initiatives.MethodsData were collected from members of the IR teams through an online survey. In addition, in-depth interviews were conducted via phone and in-person from IR team members to explore further the challenges they faced while conducting IR in Pakistan and recommendations for future IR initiatives. The qualitative information obtained from these sources was collated and categorized into themes reflecting some of the challenges, successes, and lessons learned, as well as teams’ recommendations for future initiatives.ResultsThe embedded IR Initiative in Pakistan followed several steps starting with a desk review to compile information on key implementation challenges of EPI and ended with a dissemination workshop where all the research teams shared their IR results with policymakers and implementers. Key factors that facilitated the successful and timely completion of the studies included appreciation by and leadership of implementers in generation and use of local knowledge, identification of research priorities jointly by EPI managers and researchers and provision of continuous and high-quality support from in-country research partners. Participants in the Initiative indicated that challenges included a lack of clarity on the role and responsibilities of each partner involved and need for further support to facilitate use and dissemination of research findings.ConclusionsThe Initiative established that an immunisation programme in a lower middle-income country can use small and time-bound embedded IR, based on partnerships between programme managers and local researchers, to generate information and evidence that can inform decision-making. Future embedded IR initiatives should strive to ensure effective coordination and active participation of all key stakeholders, a clear research utilisation plan from the outset, and efforts to strengthen research teams’ capacity to foster utilisation of research findings.

Improved detection of microbiological pathogens: role of partner and non-governmental organizations

BackgroundProper detection of disease-causing organisms is very critical in controlling the course of outbreaks and avoiding large-scale epidemics. Nonetheless, availability of resources to address these gaps have been difficult due to limited funding. This report sought to highlight the importance of in-country partners and non-governmental organizations in improving detection of microbiological organisms in Ghanaian Public Health Laboratories (PHLs).Methods/contextThis study was conducted between June, 2018 to August, 2019. U. S CDC engaged the Centre for Health Systems Strengthening (CfHSS) through the Association of Public Health Laboratories to design and implement strategies for strengthening three PHLs in Ghana. An assessment of the three PHLs was done using the WHO/CDS/CSR/ISR/2001.2 assessment tool. Based on findings from the assessments, partner organizations (CfHSS/APHL/CDC) serviced and procured microbiological equipment, laboratory reagents and logistics. CfHSS provided in-house mentoring and consultants to assist with capacity building in detection of epidemic-prone infectious pathogens by performing microbiological cultures and antimicrobial susceptibility tests.ResultsA total of 3902 samples were tested: blood (1107), urine (1742), stool (249) and cerebrospinal fluid (CSF) (804). All-inclusive, 593 pathogenic bacteria were isolated from blood cultures (70; 11.8%); urine cultures (356; 60%); stool cultures (19; 3.2%) and from CSF samples (148; 25%). The most predominant pathogens isolated from blood, urine and stool were Staphylococcus aureus (22/70; 31%), Escherichia coli (153/356; 43%) and Vibrio parahaemolyticus (5/19; 26.3%), respectively. In CSF samples, Streptococcus pneumoniae was the most frequent pathogen detected (80/148; 54.1%). New bacterial species such as Pastuerella pneumotropica, Klebsiella oxytoca, Vibrio parahaemolyticus, and Halfnia alvei were also identified with the aid of Analytical Profile Index (API) kits that were introduced as part of this implementation. Streptococcus pneumoniae and Neisseria meningitidis detections in CSF were highest during the hot dry season. Antimicrobial susceptibility test revealed high rate of S. aureus, K. pneumoniae and E. coli resistance to gentamicin (35–55%). In urine, E. coli was highly resistant to ciprofloxacin (39.2%) and ampicillin (34%).ConclusionDetection of epidemic-prone pathogens can be greatly improved if laboratory capacity is strengthened. In-country partner organizations are encouraged to support this move to ensure accurate diagnosis of diseases and correct antimicrobial testing.

Entrepreneurial success revisited: what Hofstede's dimensions and GEDI missed in evaluating the entrepreneurial potential in three pilot countries

This concept paper examines entrepreneurial culture and its national cultural fit according to Hofstede's dimensions and the Global Entrepreneurship and Development Index (GEDI). The authors compared expectations with the actual entrepreneurial outcomes in Pakistan, Egypt, and Zambia; three Global Entrepreneurship Program (or in-country partners) pilot beneficiaries. Although the three countries have lower GEDI rankings, they have shown considerable entrepreneurial potential based on their pertinent milestone reports. Using two of Hofstede's cultural dimensions to assess their openness for entrepreneurial initiatives, the three countries did not offer a cultural ecosystem conducive to entrepreneurship, yet the social, economic, and political contexts seemed to neutralise the cultural discord. Start-ups are seen as a counter-cyclical cushion in low-income countries to survive periods of economic downturn even when the culture does not support new ventures and risk-taking. The paper calls for an entrepreneurial construct that incorporates socio-cultural perspectives, and politico-economic factors into the innovation-led definition.