Key Informant Interviews Research Articles

The Healthy Hearts program to improve primary care for hypertension in seven rural health units of Iloilo Province, Philippines: a comparative cost study

BackgroundIn 2021, the Philippines launched the Healthy Hearts demonstration project for delivering hypertension (HTN) services in seven Rural Health Units (RHUs) in District 1 of Iloilo Province, West Visayas Region. This study evaluates the provider time cost and medication cost of delivering these services under three medication procurement scenarios, projecting them to the district and province levels to inform scaling-up efforts.MethodsA mixed-methods design was used for cost data collection, including key informant interviews (KII), focus group discussions (FGD), and secondary data sources. The HEARTS costing tool was adapted to analyze program costs per patient from the health system perspective. Three scenarios were assessed, depending on the procurement scheme of HTN medications: baseline local government procurement, pooled procurement through the Philippine Pharma Procurement Inc. (PPPI) national pooling mechanism, and private pharmacy outsourcing. We assessed annual provider labor costs and medication costs per patient for each scenario.ResultsThe average provider cost per patient was considerably lower for patients with controlled HTN than for patients with uncontrolled HTN: USD 5 (range USD 3.4–6.1 across RHUs) vs. USD 32.9 (range USD 28.8–38.4)) due to the need for more frequent follow-up visits for the latter. Average medication costs per patient were estimated at USD 9.1 (range USD 7.2–11.5) using local procurement prices, USD 2.9 (range USD 2.3–3.7) using PPPI pooled procurement prices, and USD 23 (range USD 17.9–30.5) using private pharmacy outsourced prices. The higher medicine costs in the pharmacy outsourcing scenario were partially offset by lower provider costs (an average reduction of USD 1.5 per patient per year) due to reduced on-site dispensing time in this scenario.ConclusionsThe findings from this study indicate two key opportunities for cost savings in HTN management in the Philippines' rural health units system: 1) enhancing the control of HTN, thereby reducing the need for follow-up visits and cutting down on provider time costs, and 2) utilizing pooled medication procurement mechanisms such as through the Philippine Pharma Procurement Inc. Provider time costs can also be partially reduced through outsourcing the dispensing of medications to private pharmacies, although doing so is currently associated with higher medication costs, further underscoring the utility of pooled procurement mechanisms for essential hypertension medicines.

Perceptions and experiences related to use of breastmilk from another mother in central Nepal: a qualitative study

BackgroundWhen maternal breastmilk is unavailable in sufficient quantity for infant needs, the World Health Organization (WHO) recommends the use of donor breastmilk if safe, affordable, and available. However, in Nepal and most other low- and middle-income countries (LMICs), there are significant barriers to accessing safe and affordable donor breastmilk, including a paucity of milk banks. An in-depth understanding of perceptions and experiences in Nepal related to use of donor breastmilk could inform the development of interventions to address identified barriers.MethodsFrom December 2019 to January 2020, we conducted a qualitative study, including focus group discussions (FGDs) with parents and community health workers (CHW), and key informant interviews (KIIs) with public health stakeholders in Dhulikhel municipality, Kavrepalanchowk district in Nepal. In total, 44 individuals participated in five FGDs, including two with mothers, one with fathers, and two with CHW. Nine KIIs were conducted with stakeholders. Thematic analyses of translated transcripts were undertaken to explore perceptions and experiences of participants related to use of human donor breastmilk.ResultsParticipants in this study reported that informal breastmilk sharing between relatives and neighbors is common when a mothers’ breastmilk is unavailable or insufficient and such sharing can occur via direct breastfeeding or milk expression. Numerous potential benefits with breastmilk sharing were described, including overcoming initial difficulties with milk supply in the postpartum period, convenience when mothers are unavailable, and reduced risk of infant infection and gastrointestinal distress. Hesitancies to breastmilk sharing included the risk of disease transmission from donor to infant and the possibility of decreased bonding between mother and infant. Some participants stated that animal milk is preferable to breastmilk sharing when mothers own milk is not available.ConclusionParticipants were aware of the potential benefits of donor breastmilk but identified numerous barriers to widespread adoption, including concerns about infectious diseases and mother-infant bonding, and preference for animal milks over another mother’s milk. Addressing these concerns may help increase the acceptance and practice of donating and using donor breastmilk among mothers in Nepal.

Public Ethics and Integrity Infrastructure in Ghana: Imperatives for Combating Corruption

ABSTRACT The challenge of ensuring that public servants uphold integrity and ethical conduct remains a central concern in governance and public administration scholarship. Employing contingency theory, this paper investigates the persistence of corruption and other ethical violations in Ghana despite the implementation of numerous anti-corruption reforms. Using data collected through key informant interviews with officials from anti-corruption institutions, the study identifies several persistent drivers of corruption, including the absence of ethical leadership, lack of political commitment, the politicization of corruption, selective prosecutions, weak regulatory enforcement, greed, and inadequate funding for anti-corruption bodies. The findings highlight the limitations of both compliance- and integrity-based approaches, which often fail to address these systemic challenges.

Impacts of climate change and mobile pastoralism on land use in semi-arid Ghana

This paper examines the impacts of climate change and mobile pastoralism on land use and land cover in semi-arid Ghana. A mixed methods approach, involving a household questionnaire survey, focus group discussions and key informant interviews, was employed in collecting primary data from 387 smallholder farmers. Landsat images were used to analyze land use and land cover change. The findings reveal that 99% of the respondents have witnessed severe changes in climate and pastoral movements over the past four decades, which has caused drastic alterations in environmental and resource conditions. The analysis reveals dynamic changes in land use and land cover over the studied time periods. Close and open woodlands experienced significant lost while agriculture, settlement and grassland increased. Also, water bodies witnessed an increase due to reduction in forest cover which exposed the bare land to satellite visibility. Factors driving these changes include rising temperature, declining rainfall, mobile pastoralism, urbanization, agricultural practices, and land management decisions. Such changes have implications for loss of the resources on which smallholders depend for their food security and livelihoods. Considering the changes in land cover, the study recommends agroforestry and agroecological practices to adaptation and enhance smallholder farmers’ livelihood.

Challenges and enablers to establishing COVID-19 vaccine effectiveness studies in the World Health Organization Africa region: A mixed-methods evaluation of the African region monitoring vaccine effectiveness (AFRO-MoVE) network.

Challenges and enablers to establishing COVID-19 vaccine effectiveness studies in the World Health Organization Africa region: A mixed-methods evaluation of the African region monitoring vaccine effectiveness (AFRO-MoVE) network.

Ambulance services for road traffic injury (RTI) victims in Bangladesh: a cross-sectional study on the ground realities and the way forward

IntroductionSwift and safe transport of road traffic injury patients for life-saving interventions requires a functioning ambulance system which is largely lacking in the low- and middle-income countries. This study explored...

“I felt my rights were violated”: Challenges with the discontinuation of provider-dependent contraceptive methods in Eastern Uganda

BackgroundThe right to autonomy in family planning is a cornerstone of reproductive health. Yet, many women face challenges when seeking to discontinue provider-dependent contraceptive methods, such as implants and intrauterine devices (IUDs). This study explored the experiences of women in Eastern Uganda regarding the discontinuation of implants/IUDs.MethodsUsing a qualitative descriptive design, we conducted 15 in-depth interviews with women and six key informant interviews with healthcare providers. The study obtained ethical clearance and used a thematic analysis.ResultsTwo themes were identified: (1) reasons for refusal and (2) women’s reactions to refusal to discontinue IUDs/implants. Women were denied to discontinue IUDs/implants because the due date had not been reached, insertion cards were missing, and there were healthcare constraints, especially inadequate equipment. Early removal or discontinuation before the due date was considered as a waste of resources, unjustifiable, and it was seen to increase risk of pregnancy among young girls. Healthcare workers preferred to first counsel for side effects instead of heeding women's requests to discontinue IUDs/implants. Women often felt betrayed and powerless when they were denied to discontinue using IUDs/implants. They felt that their reproductive rights were undermined which fostered mistrust towards future use of provider-dependent contraceptives. Women reported physical, social, and mental health struggles including strained marital relationships following denial to discontinue IUDs/implants. Most of the women incurred costs in discontinuing the use of IUDs/implants in private facilities.ConclusionThe findings underscore the need to uphold women’s autonomy by improving access to removal services, and addressing systemic and provider-level barriers to discontinuation of IUDs/implants. Insertion cards should not be a mandatory requirement during discontinuation of contraceptives, while enhancing record-keeping systems can address the need for insertion cards. Respecting women’s rights to discontinue contraceptives is essential for ensuring voluntary and sustained family planning use.

A study of vulnerable student populations, exclusion and marginalization in Sierra Leonean secondary schools: a social justice theory analysis

BackgroundSierra Leone faces challenges in ensuring equitable and inclusive education for all its citizens. Certain groups, including pregnant students, student mothers, students with disabilities, economically disadvantaged students, and those without family support, are particularly vulnerable to exclusion and marginalisation. These groups are identified as vulnerable based on criteria established by organisations such as the World Health Organisation and the United Nations Educational, Scientific and Cultural Organization, which highlight the interplay between health, socio-economic status, and access to education. This study explores the extent of exclusion and marginalisation experienced by these vulnerable groups within Sierra Leonean educational institutions.MethodsBetween November and December 2023, a participatory study design was utilised, employing purposive sampling to gather diverse perspectives from 127 key informant interviews with 366 participants, including teachers, parents, students with disabilities, pregnant students, students who are mothers, and economically disadvantaged students across 11 schools in six districts in Sierra Leone. The analysis was performed manually using Microsoft Word, with four researchers responsible for organising, coding, and identifying patterns and themes within the dataset.Results Pregnant students are often stigmatized, being perceived as immoral and a negative influence on their peers. This stigma results in social isolation, bullying, and derogatory comments from both peers, and at times, teachers. Students with disabilities frequently experience bullying and social exclusion; however, there are also positive examples of peer support that facilitate their inclusion in schools and the broader community. Economically disadvantaged students are often subjected to bullying and discrimination based on their socioeconomic status, which contributes to feelings of self-isolation, reduced self-esteem, and low participation in school activities.ConclusionOur study revealed that pregnant students, students with disabilities, economically disadvantaged students, and those lacking family support face stigma, social isolation, and limited access to education in Sierra Leone. These challenges are deeply rooted in societal attitudes, parental expectations, and inadequate support from teachers. To address these systemic issues, policymakers and educators should adopt comprehensive strategies, including evidence-based community awareness campaigns to challenge harmful societal attitudes, the promotion of inclusive education practices through clear and targeted policies, and the establishment of robust support services within schools. Such measures are essential to create an equitable and inclusive educational environment for all students.

Influence of key community leaders to enhance the tuberculosis awareness in the community: A mixed-method study

Abstract Background: Training community leaders about tuberculosis (TB) is considered to facilitate increased awareness in the community about TB. We studied the knowledge gap about TB and assessed the knowledge of key community leaders (KCL) about TB before and after interventions. Methods: Community-based mixed-method study which includes qualitative method and before and after study. In the qualitative method: key informant interview (KII) was conducted with stakeholders who were selected based on homogeneous purposive sampling to identify the key message (TB knowledge gap in the community) to prepare health education tools and provide focused intervention. In quantitative method (survey using questionnaire) was done with KCL from diverse sectors were selected through snowball sampling. The study was carried out for 15 months in the 14 villages, field practice area of primary health centre. Results: From key informant interview, the stakeholders stated community people awareness regarding health-seeking behaviour of TB is poor. The mean age (years) of KCL (n = 117) was 44.6 ± 10; majority (64%) were females. Knowledge regarding comorbid conditions more prone to TB, the role of alcohol/smoking in TB and extrapulmonary TB were not statistically significant. Conclusions: Leaders from diverse backgrounds were involved in the study, which helped in community participation on TB.

Declining humanitarian funding and health security threats: insights from Rohingya refugees and host communities in Ukhiya and Teknaf, Bangladesh

ABSTRACT This study examines the repercussions of declining humanitarian funding on health security for Rohingya refugees and host communities in Ukhiya and Teknaf, Cox's Bazar, Bangladesh. Utilizing a mixed-methods approach, this research integrates household surveys, focus group discussions, key informant interviews, and sector-specific reports to evaluate access to nutrition, water, sanitation, hygiene, and healthcare services. Findings reveal a significant deterioration in health security associated with funding limitations. Malnutrition rates have escalated notably, with global acute malnutrition among children reaching 15.1%. Water, sanitation, and hygiene (WASH) services are increasingly jeopardized, as 18% of individuals receive less than 20 L of water per day, while latrine access in 15 camps falls short of acceptable standards. Aged infrastructure and the ongoing reports of acute watery diarrhea continue to exacerbate health risks. Healthcare systems encounter critical challenges, including a reduction in health posts, shortages of medical supplies, and increased demand for host community clinics. This study underscores the necessity for sustained and diversified funding, integrated health, and WASH programs. It highlights the interconnectedness of resource constraints and community vulnerabilities to safeguard health security and mitigate further detrimental effects on both refugee and host populations.

Variety use and preferences among smallholder sweetpotato farmers and how best to improve their access to quality seed: A gendered perspective and implications for breeding program design

Abstract Uganda is a secondary centre of diversity of sweetpotato with most farmers maintaining at least four varieties in their fields. However, most of these varieties are landraces, with the uptake of improved sweetpotato varieties being quite low in the country, especially among women. Efforts to decrease the gender technology adoption gap are critical for inclusive impacts of innovations. This study aims to understand gendered drivers of sourcing and use of sweetpotato varieties among smallholder farmers exposed to behavioural interventions in Uganda. Key informant interviews (KII), focus group discussions (FGDs) and semi-structured interviews (SSI) were used to gather baseline information from farmers located in communities that received behavioural interventions. The results indicate that while men sourced seed-vines mainly from purchasing in the market, women farmers did so mainly from social networks including fellow farmers or neighbours. Men had higher tendency to source vines from the market likely because of higher mobility than women. Consumption traits, especially quality characteristics were strongly associated with variety use. Notably, sweet taste played a big role and was linked to preference for Iboi, Ejumula and Kakamega, the leading varieties. This was followed by high root yield. The challenges women face in sweetpotato production included limited labour force and shortage of farm equipment/machinery, lack of timely access to planting material at on-set of rains, and lack of access to affordable/ cost of improved varieties. These findings highlight the importance of paying attention to both quality and agronomic traits, and not only the latter, in variety development. They also suggest the need for implementation of effective promotional strategies including demonstration gardens, technical backstopping to extensionists to equip them, radio talk shows and market linkages.

Indigenous farmers’ knowledge and perception of desertification and soil erosion in Jigawa State, Nigeria

Desertification and soil erosion are major agro-environmental issues in Northern Nigeria. This study assessed farmers’ knowledge and perception of these phenomena in Dutse, Jigawa State, Nigeria. Data for the study was obtained through a questionnaire survey of 500 farmers, using random sampling techniques, and in-depth key informant interviews. Of the 500 distributed questionnaires, 383 were completed, representing a response rate of 76.6%. Most (86.9%) respondents were male and within the age group 35–50 years of age. Most respondents (48.6%) had 11–15 years of farming experience, with 70.5% of respondents having a large family (6–11 members) and an annual family income of < N151,000 (USD 92.61). All interviewees were aware of desertification, and most (80.2%) perceived desertification as a problem on their farm. The majority (88.3%) perceived that soil erosion had increased desertification problems and identified sand dune deposition (40.2%) and decreased crop yields (20.9%) as the main indicators of soil erosion on their farms. Most respondents identified changes in soil color as the main indicator of a depletion in soil fertility. The main (56.4%) identified soil color was reddish yellow. The major soil conservation practices employed by respondents were tree planting (52.0%) and crop rotation (26.6%). Many of the trees (62.1%) were planted as windbreaks. The main tree species planted were date palm (Phoenix dactylifera) (65.8%) and gum Arabic (Acacia senegal) (29.2%). Results of the regression analysis indicated that as the farmers’ level of knowledge and perception increased, the level of awareness about erosion and desertification also increases. However, this does not significantly influence farmers’ decision to increase the level of adoption of soil conservation measures in the study area. In summary, this study provides useful information upon which local policymakers can aid and advise local farmers to control soil erosion and reduce the rate of desertification. In addition, it also adds to our knowledge and understanding of these issues in relation to similar data obtained in other states in Northern Nigeria and other countries within the Sahelian region of Africa.

Availability, Affordability, Awareness, Preferences and Nutritional Impact of Biofortified Crops in Nigeria

Background: Nigeria has one of the highest prevalences of micronutrient deficiencies (MNDs) globally. Biofortification is a sustainable and cost-effective intervention to reduce MNDs. We investigated the current availability, affordability, individual perceptions and preferences regarding biofortified crops in three states in Nigeria (Enugu, Ogun and Kaduna). We investigated potential dietary quality improvements by modifying standardized school meals with biofortified crops. Methods: We conducted a field market survey, key informant interviews and a simulation study. The availability and prices of biofortified crops from 36 preselected markets were systematically recorded. Consumers and sellers were interviewed regarding their awareness of and preferences for biofortified crops. The inclusion of biofortified foods in weekly school meals was simulated to evaluate dietary quality improvements and costs. Three key informant interviews were conducted to understand the scalability of biofortified crops. Qualitative and quantitative techniques were employed in the data analysis. Results: Overall, 39% (total of n = 730) of the recorded crops were identified as biofortified. Biofortified cassava, sweet potatoes and millet were more expensive compared to non-biofortified equivalents. Moreover, 30% (total of n = 730) of the consumers could visually differentiate between the crops, 14% were aware that they were biofortified and 10% preferred biofortified options. The inclusion of biofortified foods in traditional school meals led to higher levels of vitamin A, zinc and iron. The key informant interviews highlighted that scaling biofortification is challenging, requiring individual behavioral change, significant investments in educational campaigns and improvements in supply and demand. Conclusions: The current state of biofortification has limited reach due to limited availability, affordability and consumer preferences.

Filming with drones: is AI the new filmmaker?

ABSTRACT Drones are intelligent as they are capable of processing vast amounts of flight data and comprehending their surroundings. They are smart AI-driven autonomous flying robots that can track objects and navigate through obstacles. The use of drones can be seen in diverse areas of media like journalism, surveillance and videography. Filming with drones offers a fresh perspective, creating a unique and thrilling experience for the viewer. Drones are the new age cinematographers powered by advanced technological image sensing. Drones can frame and record an event with a robotic gimbal during an autonomous flight with ease. This paper is an attempt to explore the capabilities of an emerging AI-powered drone filmmaking apparatus. It explores how AI is reshaping the art of filming. Key informant interviews have been conducted with travel vloggers, event drone operators, and cinematographers in the film industry for this study. Experiments with competitive consumer drones by the authors and insights from interviews conclude that AI-simulated drone maneuvers still need added manual controls for a precise flight trajectory and shot taking. However, these aerial camera bots are becoming more autonomous with every upgrade.

“I feel like my job is to give patients hope” - perspectives of Community Health Workers and employers in Iowa: a mixed methods study

IntroductionCommunity Health Workers (CHWs) play a crucial role in extending health services, particularly for people who are medically underserved. Despite efforts to expand CHW programs nationally and in Iowa, challenges persist in defining their roles and responsibilities. Few studies have considered the perspectives of both CHWs and CHW employers simultaneously.MethodsWe conducted an exploratory sequential mixed-methods study, first involving key informant interviews with CHWs and employers, which then informed the development of surveys distributed to both populations. We performed thematic analysis of qualitative data and calculated descriptive statistics of quantitative data.ResultsKey informant interviews were conducted with five CHWs and five employers. An additional 123 CHWs and 81 employers responded to the survey. From the interviews, we report six themes, including roles and responsibilities, interaction with the broader health care team, and support needed. Survey respondents reported 69 unique job titles, a wide range of populations served, and diverse training needs. Despite 93.6% (n = 102) of CHWs receiving on-the-job training, 48% (n = 52) indicated they would still benefit from more training to be effective in their roles. 46% (n = 21) of employers reported unstable funding as a major barrier to program implementation.DiscussionCHWs in Iowa felt supported and valued as members of the care team, yet challenges to growing the CHW workforce remain. Our findings highlight the need for continued role definition of the CHW workforce, as well as the need to establish more sustainable sources of funding to ensure the continuity and expansion of this health equity-enhancing workforce.

Migration and agricultural development in the Santchou Landscape of Cameroon

Agricultural development is a recurring process in many parts of sub-Saharan Africa. Despite this, the extent to which micro-level changes triggered, for instance, through migration, shape agricultural development still accounts only for a very negligible amount in the literature. Using the case of Santchou, an agro-dynamic landscape in Cameroon, this paper analyses the source and typology of migrants in three communities and evaluates the effect of migrants on the type of agricultural practices. A representative sample of 149 households was conducted in four communities within the landscape. This was complemented by key informant interviews (N = 5). Based on the analysis, the following conclusions are plausible: Firstly, while economic migrants account for a very significant proportion of the migration picture in the Santchou landscape; the over half a decade of socio-political crisis in parts of Cameroon has equally triggered massive in-migration into this area. Secondly, the most significant effect of migration is the increase in the adoption of technological innovations in agriculture and the shift from extensive to intensive agriculture. The latter is associated with the increasing introduction of market gardening—a practice which is predominant at their source location (North West Region). Thirdly, a comparison of three steps of land cover/use change in Santchou showed that between 2003 and 2023, a more than 60% increase in the surface area covered by arable land was registered. This paper provides empirical evidence to edify migration literature with an emphasis on the role of in-migrants in shaping agricultural development practices.

Take home messages from the implementation of the primary health care measurement and improvement (PHCMI) initiative in the WHO Eastern Mediterranean Region (EMR).

To summarize the findings from the PHC Measurement and Improvement (PHCMI) initiative in the World Health Organization WHO Eastern Mediterranean Region (EMR) and highlight key lessons to build PHC-oriented health systems. To support countries in enhancing their commitment to the primary health care (PHC) approach, the WHO Regional Office for the Eastern Mediterranean (EMRO) established the PHCMI initiative in 2019 to evaluate PHC performance and identify priorities for improvement. Building on the experience of the global PHC Performance Initiative (PHCPI), PHCMI updated the master indicator list through iterative processes and reflecting country priorities. Progress in five domains: system/structure, inputs, processes, outcomes, and impact was assessed. Existing policy documents, data sources, and key informant interviews were used in the assessment. Of the 21 countries and one territory, 14 participated in the assessment including Afghanistan, Bahrain, Egypt, I.R. of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Oman, Pakistan, occupied Palestinian territory, Qatar, and Yemen. Despite the observed heterogeneity in PHC implementation, most countries reported that public primary care services were acceptable, accessible, and affordable. Strong leadership, the existence of PHC-related national health policies, and the engagement of stakeholders were key success factors.Areas for additional attention include the need to increase investment in PHC, increase the PHC workforce, enhance equitable distribution of the workforce, expand training of primary care clinicians, improve health information systems, and inform the population on the benefits of preventive care. Health systems should be more tailored to the PHC approach and encouraged towards a more holistic view of the PHC approach.The PHCMI initiative provides a foundation for an open discourse for advancing universal health coverage (UHC) and health security in EMR and re-orienting health systems towards the PHC approach.

When the basic seems like a luxury: Menstrual friendly public toilets in six cities.

When the basic seems like a luxury: Menstrual friendly public toilets in six cities.

Is Contract Farming Fair For Smallholder Farmers? A Case Study From India

This article develops a theoretical lens and conceptual framework to measure fairness in contract farming from the perspective of smallholder farmers. By employing concepts from “fairness theory,” “network analysis and exchange theory,” and “responsible contract farming,” 24 indicators are identified for measuring fairness. Using mixed methods research, two phases of fieldwork were conducted in the potato-producing districts of Hooghly and Bankura. In the first phase, 12 focus group discussions were conducted with 90 contract farmers and 31 key informant interviews with PepsiCo intermediaries. In the second phase, a household survey was conducted, covering information from 130 contract and 133 non-contract potato farmers. The study revealed a lack of fairness in contract farming arrangements, failing to meet majority-of-fairness measures. PepsiCo influences contract negotiations related to pricing and quality, with intermediaries following their directives and leaving farmers without a say. Further, intermediaries control farmers over pricing, input provision, quality standards, and rejections. This article argues that contract farming enables corporations to control agriculture through intermediaries, ensuring a steady supply of quality raw materials from a class of needy and highly dependent small farmers.

Understanding stigma as a barrier to cancer prevention and treatment: a qualitative study among people living with HIV in Uganda and Zambia

ObjectivesExtended life expectancy due to treatment improvements has increased the diagnosis of cancer among people living with HIV (PLWH) in Africa. Despite documented impacts of stigma on cancer preventive behaviours...