Local Good Practices Research Articles

Improving diagnostic of cervical dysplasia among postmenopausal women aged ≥50 years using local vaginal oestrogen treatment prior to colposcopy: study protocol for a multicentre randomised controlled trial (the IDEAL study)

IntroductionColposcopy is the most important diagnostic tool to detect cervical precancerous lesions and thereby prevention of cervical cancer. Due to age-dependent changes of the cervix, colposcopy is challenging in postmenopausal...

Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy

ABSTRACT Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers’ performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

How to ensure the sustainability of good practices transfer to heterogeneous contexts? Sharing the results of the JADECARE Joint Action

Summary: This workshop presents the general results of the implementation process of JADECARE and explores the key elements to support the sustainability of good practice transfer beyond the Joint Action.
 It presents the JADECARE Sustainability strategy that sets three core elements: policy environment, ownership of sustainability and culture of collaboration and consensus seeking.
 Two Next Adopters (NAs) adopting and transferring good practices will present the results of the implementation of their local good practices and their work to build sustainability beyond JADECARE.
 Background: JADECARE (the Joint Action on digitally enabled integrated person-centred care) contributes to innovative, efficient and sustainable health systems, providing expertise and sharing good practices to assist the Member States in undertaking health system reforms. It enables the participating national authorities and those beyond the Consortium, to benefit from efficient solutions in digitally enabled integrated person-centred care via supporting best practice transfer to 21 other settings of Next Adopters.
 Aim: Share the results of the implementation process of JADECARE and explore the key elements to ensure the sustainability of local good practices beyond the Joint Action.
 Objectives:
 -Share the results of the JADECARE transfer and adoption process
 -Present the JADECARE Sustainability strategy
 -Promote the discussion among attendees to highlight the key elements to ensure sustainability and scale up of local good practices beyond the project
 Target audience: Policy makers, decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and staff working on implementation of integrated care, digitalization and/or evaluation.
 Facilitators/speakers: Yhasmine Hamu and Ane Fullaondo (Institute for Health Services Research Kronikgune ) will introduce the workshop, present the general implementation results, moderate and facilitate the thematic discussion.
 Jelka Zaletel and Denis Opresnik (NIJZ) will present the JADECARE Sustainability strategy.
 Chiara Ferravante (ARS Tuscany) and Martina Zorko, Karmen Janša (ZZZS) with Jelka Lindič (Slovene Nephrology Society) representing two NAs will expound the results of their transfer and adoption process highlighting the holders of sustainability beyond JADECARE.
 Format: (90’)
 5’-Introduction and workshop objectives – Ane Fullaondo
 10’- JADECARE transfer and adoption general implementation results – Yhasmine Hamu
 15’- JADECARE Sustainability strategy – Jelka Zaletel and Denis Opresnik 
 15’- Implementation of local good practices within JADECARE with a focus on sustainability – Results from two NAs- Chiara Ferravante, Martina Zorko, Karmen Janša and Jelka Lindič
 40’- Thematic discussion. All participants will be divided into two stations where brainstorming about two topics related to “Key elements to ensure the sustainability and scale up of practices beyond a Joint Action” will be facilitated and harmonised by two moderators. After half of the time the groups will exchange the discussion topic.
 5’- Sharing of main conclusions and Take home messages
 Key Learnings/Take away:
 ‒Learnings on the JADECARE transfer and adoption implementation results
 ‒Understanding about the actions undertaken by the NAs for building sustainable local good practices
 ‒Awareness about the challenges related to the sustainability of good practices transfer to heterogeneous contexts

Industrial symbiosis and industrial policy for sustainable development in Uganda

The aim of this article is to analyze how the concept of circular economy and especially the business model of industrial symbiosis can contribute to sustainable development in Uganda. We aim to add to emerging debates around green industrial policies by shedding light on a low-cost solution that can potentially promote a more sustainable industrialization in the Sub-Saharan African context. After sketching the regulatory and policy environment in Uganda, three indicative examples of industrial symbiosis in Uganda are analyzed, based on the result of field research and an online survey. We have found significant mismatch between the supply side of green industrial policies in Uganda (government aims and measures), and the demand side, what local green entrepreneurs would need to improve their competitiveness. Only an incentive and regulatory framework, that takes into account local specificities, builds upon the exploration of existing local good practices and incorporates bottom-up initiatives can successfully promote green development in low-income economies.

A Review of Rock Slope Stability Assessment Practice in Malaysia

Rock slope stability assessment in Malaysia has become increasingly important as new developments encroach hillsides around major cities. This article reviews historical case studies to present a general picture of rock slope assessment practice in Malaysia, especially on methods and output of the case studies. Common methods include use of locally developed rating systems, Rock Mass Rating (RMR) and its derivatives, kinematic analysis, and numerical analysis. Application of these methods must be suitable with site conditions, while its advantages and disadvantages must be recognized by the assessor. Emergence of new technologies greatly improves the speed and quality of data acquisition provided. A total of 39 case studies on different lithologies were examined, in which progress were notable from kinematic analysis-based assessments to incorporation of rating systems and numerical analysis. This article recommends several improvements for rock slope assessment practice. These include an establishment of a local good practice guide in the assessment, incorporation of numerical analysis into standard practice, improving utilization of new technologies, more attention to the influence of weathering, and consideration of seismic influence in seismically active regions. Utilization of numerical methods and other contemporary methods reflects increasing understanding of rock mechanics which is vital to rock slope stability assessment among local practitioners. Improved rock slope assessment allows for a more accurate stability determination and decisive mitigation measure recommendations, which is to be done by competent engineering geologists, in line with Geologist Act 2008.

MO213GOOD PRACTICES FOR DIALYSIS EDUCATION, TREATMENT AND EHEALTH: A SCOPING REVIEW

Abstract Background and Aims Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment and eHealth. Method Embase, Pubmed, and the Cochrane Library databases were searched for relevant articles using all synonyms for the words ‘kidney failure’, ‘dialysis’ and ‘good practice’. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results. Results Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and unbiased predialysis education, assisting PD patients in adequately performing PD, educating HD patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life. Conclusion The results of our scoping review can inspire nephrological health care professionals to change their practices and these good practices could be used in addition to guidelines. It is important to increase the attention for local good practices, because they can truly support health care professionals and can improve outcomes and quality of life for patients, even if they are not evidence-based.

Exploring commissioners' understandings of early primary care network development: qualitative interview study.

BackgroundPrimary care networks (PCNs) are financially incentivised groupings of general practices in the English NHS. Their purpose is to deliver a number of policy goals set out in The NHS Long Term Plan. Clinical commissioning groups (CCGs) have a role in their establishment, support, and oversight.AimTo explore commissioners’ perspectives on the early development of PCNs.Design and settingQualitative study of CCG staff using telephone interviews.MethodSemi-structured interviews were carried out with 37 CCG employees involved in PCN establishment. Interviewees were asked about local PCNs’ characteristics, factors shaping development and form, activities to date, challenges and benefits, and their CCGs’ relationship with PCNs. Interviewee responses were summarised within a matrix and analysed thematically.ResultsThree meta-themes were identified: the multifaceted role of the commissioner, tensions between PCN policy and locally commissioned services, and engaging the broader system. Interviewees reported that the policy potentially favours those PCNs working from a ‘blank slate’ and does not sufficiently account for the fact some GP practices and wider system organisations have been doing similar work already. The prescriptive, contractual nature of the policy has led to local challenges, trying to ensure that local good practices are not lost during implementation. Interviewees also considered an important part of their work to be protecting PCNs from the weight of expectations placed on them.ConclusionCCGs are well placed to understand the complexities of local systems and to facilitate PCNs and working practices between wider system partners. It is important that this local role is not lost as CCGs continue to merge and cover larger geographical populations.

Advancing urban green infrastructure through participatory integrated planning: A case from Slovakia

Cities provide a locus for sustainability: they will soon accommodate most of the world’s population, just as increasing environmental and climate emergencies and socio-economic inequalities constitute major challenges. The concept of urban green infrastructure (UGI) offers a greenspace planning approach based on a grounded set of principles to improve the environmental health and liveability of cities. A wide variety of greenspace planning and implementation approaches is already being applied within and across countries. This paper employs UGI as a research lens to critically evaluate planning trends in Slovakia on national, regional and local levels. To this end we have analysed planning documents, interviewed greenspace agents and evaluated local good practice. Our results indicate weak instrumental support for UGI planning, as well as other systemic and procedural barriers to green infrastructure. Moreover, a comparison with observations from other European planning systems reveals notable commonalities and differences. The paper then discusses a local greening programme and bottom-up actions as potential ways to foster green infrastructure development. Local practitioners can initiate important planning processes by employing nature-based practices, engaging with stakeholders and promoting functional approaches. We propose a participatory integrated model that utilises the opportunities embedded in bottom-up actions. Our model can be adopted in higher-level planning and policymaking if appropriate operational and mediating interventions take place.

How to design an education programme for patients with chronic obstructive disease?

Introduction: COPD is a debilitating disease and a major death cause by 2020. Our current knowledge of the opportunities of patient education in the community pharmacy is growing, though yet limited.
 Objectives: (1) To assess the potential of a patient education programme in a Hungarian pharmacy, (2) to understand patient attitudes and gather insight for the development of an education project, (3) to create a sustainable local good practice.
 Methods: We invited patients with a confirmed COPD diagnosis to take part in an in-depth interview, and to assess their symptoms. Later on, we offered them tailor-made education to learn about their attitudes to create the guidelines for optimal content. 
 Results: Key elements of the education content should focus on the desire of active life, improve poor adherence, teach about reliever and maintenance therapy and emphasise the chronic component of the disease. Smoking cessation should be fostered, whilst patients would benefit from proper breathing techniques and posture. 
 Conclusion: Hungarian patients may prefer to get fast and basic education in the community pharmacies. The ideal education content should include pathophysiology, signs and symptoms, treatment options, explanation of medication, inhaler use, smoking cessation and breathing techniques.

Brain Drain in the EU: Local and Regional Public Policies and Good Practices

The processes of brain drain and brain gain are in public debate today, just as they were more than 2,000 years ago or when the first European universities were established. The debate is far from over and the issue is debated both at the academic and political level. There are several interconnected levels at which the issue needs to be addressed and solutions found: local, regional, national, and supranational (EU). Coordination of different funding sources should be improved at the EU level in the governance of post-2020 cohesion policy and programs. The local and regional authorities can best analyze the specific needs of communities and find answers to them and thus play an important role in reducing the potential negative effects of brain drain processes and can support brain gain, brain regain and brain circulation processes. There are many examples of public policies and practices implemented by local and regional authorities - from supporting the relocation of talented individuals to those regions/cities to more sophisticated measures involving the development of transnational networks of entrepreneurs. The EU needs to support programs or initiatives that aim to enhance learning between different European local and regional authorities and the efforts of local and regional public bodies in addressing brain drain.

Technical and Agronomical Assessment of the Use of Desalinated Seawater for Coastal Irrigation in an Insular Context

The growing need for alternative water resources for irrigation has led to advanced technological developments, which are addressing some of the challenges that our planet is facing regarding the water supply. The Canary Islands Archipelago (Spain) is a singular territory with several years of desalination experience while using desalinated seawater (DSW) for agricultural purposes. The current paper will address the conducted research of one of the case studies done into the Horizon 2020 project MAGIC, with the aim of analyzing the use of DSW for crop production in the Southeast of Gran Canaria Island. A methodology of surveying farmers in the area has been put in practice, as well as an assessment of potential soil degradation risks that are related to DSW irrigation (with fifteen years of DSW data). Additionally, local good practices to improve the DSW quality for irrigation are discussed. This study demonstrates an excellent endorsement of the surveyed farmers in the studied area regarding the use of DSW for irrigation: the strategy of combining this type of water with other water resources, such as groundwater and/or reclaimed water is very frequent and it can guarantee water and food security in the island’s territory.

The roots of the city. Creative food systems in European small towns

Resumo 
 Esta comunicação apresenta os resultados do projeto AGRI-URBAN financiado pela UE, onde um grupo de onze cidades europeias de pequena e média dimensão, com uma especialização relativa na produção agroalimentar, explorou formas de repensar os seus sistemas alimentares. O projeto teve um liderança politica alicerçada num conjunto de atores locais interessados no sector agroalimentar que participaram nas diferentes fases do projeto, nomeadamente: planeamento e implementação. Os principais objetivos do projeto foi desenvolver um sistema inclusivo, coerente e reflexivo de governança alimentar rural-urbana, através de: planos de ação integrados; criar uma infra-estrutura social e física mais sólida para reduzir a distância entre produtores e consumidores, promovendo assim uma economia circular; criar mercados fiáveis para produtores de alimentos de qualidade, resultando em novas oportunidades para o desenvolvimento das PME; experimentar novas formas de empreendedorismo no sector agrícola e criar novos postos de trabalho e competências ligados ao sistema agroalimentar. Uma das mais valias do projeto foi facilitar a troca de conhecimento e aprendizagem entre cidades através de uma série de visitas "transnacionais" que permitiram aos parceiros do projeto participar em grupos de discussões e desenvolver um entendimento mais aprofundado do tema, bem como experienciar exemplos concretos que estão em pratica nas diferentes cidades e criar oportunidades de networking. A comunicação evidencia as diferentes iniciativas de nível local e de “bottom-up” que as cidades ativaram por meio de processos inovadores, novos modelos e estratégias de negócios, organizados em torno de quatro tópicos transversais: Garantindo curtos-circuitos; Uso inteligente da terra; Desenvolvimento de negócios de PMEs e compras públicas locais, e como estas iniciativas foram articuladas em agendas alimentares urbanas sustentáveis.

TSUNAGARI: a new interdisciplinary and transdisciplinary study toward conservation and sustainable use of biodiversity and ecosystem services

AbstractThe expanding economical activities have accelerated losses of biodiversity and ecosystem services, which are especially pronounced in Asia. To find solutions to stop these losses, a group of scientists studying both ecological and social sciences has launched an interdisciplinary research network, entitled TSUNAGARI (Trans‐System, UNified Approach for Global and Regional Integration of social‐ecological study toward sustainable use of biodiversity and ecosystem services). The project is based on two main perspectives: (1) integrating different disciplines of environmental research across multiple spatial scales, and (2) evaluating the importance of ecosystem connectivity between land and ocean for biodiversity and ecosystem services. The integrative studies have been started as follows: (1) integrating global‐scale analyses of biodiversity and economy by developing GIS‐based footprint analysis, (2) establishing the link between the studies of local good practices of ecosystem management and life cycle assessment on ecosystem good and services, (3) linking local‐scale ecosystem studies to decision making processes for sustainable society by multiple stakeholders, and (4) upscaling local analyses of ecosystem processes to broad‐scale analyses of ecosystem patterns. The proposed approaches are considered effective to solve problems that impede conservation of biodiversity and sustainable use of multiple ecosystem services in various situations although we also find some gaps such as regional biases in biodiversity data and involvement of different types of stakeholders. By overcoming the major bottlenecks, we believe the new integrated approaches will promote conservation and sustainable management of biodiversity and ecosystem services research, and contribute to advance decision‐making processes from local communities to international levels.

English

Civil society role is often seen as less powerful agent in forming or maintaining good governance than two dominant agents (state and private actors). This research is intended to have knowledge whether civil society can play important roles in forming and maintaining local good governance in Surakarta City, Indonesia. The civil society (both formally and informally associations or persons) in Surakarta city plays very pivotal roles in six sustainable elements, namely (1) by influencing policy analysis and advocacy; (2) by controlling regulations; (3) by monitoring local government actions and behavior of staff officials; (4) by enabling citizens to identify and articulate their values, beliefs, civic norms and democratic practices; (5) by mobilizing vulnerable and marginalized masses to participate more fully in politics and public affairs and finally (6) by establishing participatory development work to improve their own better life. Interestingly, there are two new factors found in the research in determining the success of sustainability of local good governance practices in Surakarta, namely informal networking or communication and spirit of togetherness. The existence of civil society (especially the informal one) in Surakarta City is a strong pillar for sustainable local good governance practices. Maintaining this strong civil society role will make it possible to guarantee the future of the good governance in Surakarta City, Indonesia.

Low-Cost Improvements for Reducing Multifaceted Work-Related Risks and Preventing Stress at Work

Types of low-cost improvements that can help reduce work-related risks and prevent stress at work are reviewed by examining simple improvements achieved by participatory action-oriented programs in different work settings. Programs reviewed include WISE (work improvement in small enterprises) projects in various industries, including POSITIVE (participation-oriented safety improvements by trade union initiative) activities by trade unions, and recent mental health interventions for work stress prevention. Participatory steps undertaken commonly comprise learning local good practices, group work on feasible improvement options and consensus building on immediate actions. These common steps are found effective for achieving multifaceted improvements at low cost in short periods. Typical low-cost improvements by work improvement programs cover materials handling, workstations, physical environment and work organization, whereas those by stress prevention programs additionally cover internal communication, restful schedules and social support measures. The planning and implementation of these improvements are usually facilitated by the use of action-oriented toolkits including good examples, action checklists listing practical low-cost improvements and group work sheets. Serial intervention studies confirm reductions in workplace risks, often with productivity increase, in both work improvement and stress prevention activities. Main contributing factors leading to these positive achievements are (a) simple procedures aimed at good practices in multifaceted risk management, (b) a clear focus on locally feasible improvements that have real impact on risk reduction, and (c) the use of locally adjusted action-oriented toolkits. These results demonstrate the importance of promoting participatory programs relying on multifaceted low-cost improvements in reducing the work-related risks and stress in varied work situations.

Operating Urban Elements for Cities in Transition from Socialism to Capitalism

The main research topic is the city in the period of transition from socialism to capitalism and the associated attitudes towards urban planning. A case study was conducted on the city of Split, in particular the area called Split 3. The aim was to establish the mode of operating in contemporary conditions of urban planning and reconstructing small cities of up to 300,000 inhabitants by learning from local good practices. We used textual and graphic materials as the basis for exploring the programming, planning and realization of city construction for 50,000 inhabitants that took place during socialism, and its subsequent development under capitalism. Establishing usability of the then forms in present-day life followed. To this end, we analyzed the neighborhood unit proposed by C.A. Perry in 1929, the typical neighborhood proposed by the Urban Task Force headed by Richard Rogers in 1999 and the fused grid proposed by the Victoria Transport Policy Institute in Canada in 2012 – and compared it with the urban unit used in Split 3.

Findings of the Work Improvement on Board (WIB) programme by the Fishery Agency in Japan

Concerns are growing about the safety and health of seamen exposed to high risks while working on vessels. Their accident rate in 2013 was 9.9 per 1000 workers, 5 times higher than that in industry. In order to mitigate the risks of seamen, we developed the Work Improvement on Board (WIB) programme by applying participatory action-oriented training (PAOT) methods that have proven effective for reducing work-related risks in small enterprises, construction sites, and agriculture. We analysed which features of the WIB programme would be most effective for facilitating the planning and implementation of practical improvements on vessels. We examined action -oriented tools used, including a WIB action checklist and good examples, and practical improvements proposed by the participants in 1-day or half-day WIB workshops. To study the effectiveness of the WIB programme, we analysed 1121 replies of a questionnaire distributed to 1459 participants of the programme. We compared the types of improvements achieved and the improvement costs in the WIB programme with those in other PAOT programmes. The impact of the WIB programme on promoting primary prevention by seamen and fishermen was discussed. The action checklist listing practical improvements on board and good example photos apparently facilitated the planning and implementation of improvements feasible on board. The participating crews could propose readily applicable improvements of their vessels within short time. In the case of workshops held in 10 harbours between August and October 2014, participants coming from 110 vessels presented 228 improvement proposals which were mostly feasible at low cost. Among the 1121 questionnaire replies from participants of the WIB programme, over 75% evaluated the programme as necessary, practical and easy-to-understand. These positive results led to the adoption of the WIB programme for training fishermen and seamen on commercial vessels by the Fishery Agency and the Ministry of Land, Infrastructure, Transport and Tourism. The Fishery Agency adopted plans to improve the working environment on fishing vessels by training 500 fishermen per year in the WIB programme from 2013 to 2018. The participatory work improvement programme can work in vessels when it utilises in a flexible manner local good practices and low-cost improvements as guides. The use of action-oriented tools such as a WIB action checklist and good examples seems important. We recommend the wide use of WIB methods in occupational safety and health management systems on board vessels in Japan and other countries.

Roles of Participatory Action-oriented Programs in Promoting Safety and Health at Work

Reflecting the current international trends toward proactive risk assessment and control at work with practical procedures, participatory action-oriented approaches are gaining importance in various sectors. The roles of these approaches in promoting the safety and health at work are discussed based on their recent experiences in preventing work-related risks and improving the quality of work life, particularly in small-scale workplaces. The emphasis placed on the primary prevention at the initiative of workers and managers is commonly notable. Participatory steps, built on local good practices, can lead to many workplace improvements when the focus is on locally feasible low-cost options in multiple aspects. The design and use of locally adjusted action toolkits play a key role in facilitating these improvements in each local situation. The effectiveness of participatory approaches relying on these toolkits is demonstrated by their spread to many sectors and by various intervention studies. In the local context, networks of trainers are essential in sustaining the improvement activities. With the adequate support of networks of trainers trained in the use of these toolkits, participatory approaches will continue to be the key factor for proactive risk management in various work settings.

Practical Ways to Facilitate Ergonomics Improvements in Occupational Health Practice

Recent advances in participatory programs for improving workplace conditions are discussed to examine practical ways to facilitate ergonomics improvements. Participatory training programs are gaining importance, particularly in promoting occupational health and safety in small-scale workplaces. These programs have led to many improvements that can reduce work-related risks in varied situations. Recent experiences in participatory action-oriented training programs in small workplaces and agriculture are reviewed.The emphasis of the review is on training steps, types of improvements achieved, and the use of action tools by trainers and training participants. Immediate improvements in multiple technical areas are targeted, including materials handling,workstation design, physical environment, welfare facilities, and work organization. In facilitating ergonomics improvements in each local situation, it is important to focus on (a) building on local good practices; (b) applying practical, simple improvements that apply the basic principles of ergonomics; and (c) developing action-oriented toolkits for direct use by workers and managers. This facilitation process is effective when locally designed action toolkits are used by trainers, including local good examples, action checklists, and illustrated how-to guides. Intervention studies demonstrate the effectiveness of participatory steps that use these toolkits in promoting good practices and reducing work-related risks. In facilitating ergonomics improvements in small-scale workplaces, it is important to focus on practical, low-cost improvements that build on local good practices. The use of action-oriented toolkits reflecting basic ergonomics principles is helpful.The promotion of the intercountry networking of positive experiences in participatory training is suggested.

Postcolonial perspectives on aid systems in multicultural contexts: Palestine and Uganda

The care systems in developing countries are subjected to worldwide standard guidelines, in which the western voice is dominant over the local one. Our study aims to point out dominant themes emerging from western care system applied to non-western contexts, to emerge cultural sensitive themes in order to propose alternative local good practices. The two studies, the first curried out in Palestine, the second one in Uganda, have been focused on a content analysis of in depth interviews and representative documents of local institutions. A general unbalance over western criterion was widely identifiable in the two case studies of these papers. Programs of action research are recommended.