Multi-sector Project Research Articles

Co-creation and priority setting for applied and implementation research in One Health: Improving capacities in public and animal health systems in Kenya

BackgroundThe Kenyan government has successfully been implementing sector specific and multisectoral projects aligned to the Global Health Security Agenda (GHSA). For operational readiness and to enhance the effective planning and implementation of Global Health Security Programs (GHSP) at national and subnational level, there is an urgent need for stakeholders' engagement process to seek input in identifying challenges, prioritise activities for field implementation, and identify applied research and development questions, that should be addressed in the next five years. MethodsThe modified Child Health and Nutrition Research Initiative (CHNRI) method was used to identify global health security related priorities for multisectoral implementation in Kenya. Subject matter experts from human, animal and environmental health sectors at national and subnational level contributed to predefined research questions from a number of sources and activities for consideration for implementation using a One Health approach. Sixty-two experts scored the 193 questions based on five pre-defined criteria: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Data resulting from this process was then analysed in a Microsoft Excel spreadsheet to determine the research priorities and experts' agreements. ResultsAmong the priority activities identified for implementation research were; strengthening One Health governance and legal frameworks; integration of ecosystem health into One Health programming; strengthening disease reporting, integrated data collection, information sharing and joint outbreak response; socio-anthropological and gender-based approaches in improving risk and behavioural change communication and community engagement; and one health workforce development. In addition, the potentials to invest in collaborative predictive risk modelling to enhance epidemic intelligence systems, while strengthening the One Health approach in the food safety incident and emergency response plans are feasible. InterpretationSuccessful multisectoral implementation of global health security program in Kenya calls for a whole of society approach that will harness community and private sector knowledge to build preparedness and response capacities while targeting neglected and marginalised populations. This research provides a framework that is worth emulating for cost-effective planning and implementation of overarching One Health programs.

Multisectoral approach to address Female Genital Mutilation: a case study from Portugal

Abstract Issue Female genital mutilation (FGM) comprises all procedures that injury female genital organs for non-medical reasons, with several health impacts. Due to global migration, FGM has been increasingly recognised as a healthcare issue in Europe, affecting nearly 1 million women. In Portugal it is estimated that 5483 migrant women have undergone FGM in the Lisbon region. Intervention is required to tackle this issue. Description Portugal launched the “Healthy Practices: End of FGM”, a multiagency project targeting Lisbon and Tagus Valley region. Project implementation started in Nov 2018 at 5 local public health units (PHU) and was scaled-up to 5 more in Feb 2020. Project comprises 3 main axes: 1) inclusion in public policy instruments; 2) professionals’ education and awareness; and 3) community intervention. We describe inclusion of FGM in public policy, professionals training and changes in FGM recording before and after intervention. Results Between 2018-2022, inclusion of FGM in municipalities’ migration policies doubled. Between 2019-2021, 110 training sessions (n = 1722 professionals) were promoted. During pandemic years, only 344 (2020) and 202 (2021) were trained. Raising awareness and empowerment to risk communities happened mainly through local/online open sessions, workshops, flyer distribution, video projections. These occurred in all 10 PHU, mostly through partnerships with Non-Governmental Organizations and municipalities. According to the Portuguese Health Records, until 2018 there were only 300 women registered with FGM. Between 2019-2021, 363 more were added. Lessons The multisectoral approach allowed PHU professionals to collaborate directly with external organizations from different society sectors. COVID-19 pandemic posed a challenge to implementation, especially in the community intervention axis. Notification numbers increased after interventions, though causality could not be established and impact evaluation is yet to be performed. Key messages • Multisectoral projects for FGM intervention have specific implementation challenges, including how to justify and evaluate them, that must be considered in each setting. • Training health professionals might increase identification and notification of FGM, but the impact in preventing FGM in the Portuguese reality is still largely unknown.

Problem Management Plus Adapted for Group Use to Improve Mental Health in a War-Affected Population in the Central African Republic

A large number of the population in the Central African Republic has been exposed to potentially traumatic events as a result of the last conflict, which has led to the breakdown of social ties. In response to this situation, the nongovernmental organisation, Action contre la Faim, proposed a multisectoral project aimed at helping internally displaced persons to find an income-generating activity and offer psychosocial support through the adaptation of the Problem Management Plus protocol. A total of 946 IDPs in the country’s capital participated in the group intervention led by a team of paraprofessionals. Data collected from 111 participants showed that after 5 weeks of intervention, there was a significant reduction in posttraumatic symptoms and functional impairment. These results were confirmed during the postintervention evaluation 4 weeks later. In addition, participants declared that they had observed effects in their ability to live together in the community and in regaining a certain level of social cohesion. This experience gives encouraging results with regard to the feasibility and replicability of the adapted group protocol, taking into account specific cultural and contextual adaptations.

The ‘creative township’ in the post-apartheid: globalisation, nation building or gentrification?

ABSTRACT This paper analyses the ambiguities of post-Apartheid public cultural policies in South Africa by focusing on the case of the Red Location Museum and Cultural precinct (RLMCP), a multisectoral project for socio-economic development, based on tourism, art, culture, heritagisation and urban regeneration, implemented in Red Location, one of the oldest townships of Port Elizabeth. In the post-Apartheid period, cultural policies have been employed as catch-all policies that could lead to urban renewal, desegregation and development. The case of the RLMCP drives home how efforts to use art and culture as leverages to transform townships into the core of the creative city and into the prototype of a new form of neighbourhood led to exclusionary representations and patterns; moreover, it is an example of how cultural policies enforce gentrification dynamics at the local level, in the name of restructuring urban governance and rescaling the city to the global dimension.

Evaluation of 3D skin model-based assays using difficult to test substances: an EPAA multi-sector project

Evaluation of 3D skin model-based assays using difficult to test substances: an EPAA multi-sector project

Defining, achieving, and evaluating collaborative outcomes: a theory of change approach

ABSTRACTGovernments have repeatedly claimed that collaboration improves public service outcomes. However, defining, achieving, and evaluating collaborative outcomes is often problematic. Analysis of multi-sectoral projects in Wales, which were supported by the European Social Fund, exemplifies these challenges. Shifts in policy discourses and the interplay between national and local agendas produced complex and contested understandings of outcomes which made difficult to evaluate the projects’ achievements. We argue that the pursuit of collaboration needs to be understood not simply as an attempt to improve public service effectiveness but also ‘cultural efficacy’. The conclusions offer reflections relevant for theory and practice.

Youth Services System Review: Moving From Knowledge Gathering to Implementation Through Collaboration, Youth Engagement, and Exploring Local Community Needs

This article describes a two-phase, multi-sectoral project aimed at enhancing youth services addressing substance use in Ontario. In the information gathering phase, a youth-focused website and survey, focus groups, and interviews were used to elicit perspectives from multiple stakeholders. In the implementation phase, capacity-building and consultations on transition-aged youth needs were conducted to inform youth transition-readiness checklists. We discuss the importance of engaging youth as collaborators as well as respondents and the processes used to tailor findings to local contexts for implementation.

Ripple effect: An evaluation tool for increasing connectedness through community health partnerships

We used a community-based participatory approach to evaluate a multi-sectoral project called Hermosa Vida. Project partners and community researchers collaborated on the design and implementation of a Ripple Effect Tool (RET) to measure increased generative social and professional connectedness, and new project development in an emergent participatory project. Participatory methods drove evaluation of the development and intended documentation of emergent project goals. Findings of the RET suggest saliency in increased connectedness for project partners, participants, and communities, though benefits were tiered with maximum impact of connectedness occurring at leadership levels of programmatic involvement. In light of growing evidence that increased connectedness is directly related to health outcomes, the participatory development of a RET is useful for midcourse correction, ensuring ongoing commitments to participatory and engaged project goals, and measuring and prioritizing capacity building. Use of a locally developed RET could increase connectedness and partnerships among all project partners, reaching beyond layers of advantageous positioning within complex partnerships.

The Development Project as an Institution for Agency and Capability Expansion: The Case of the Njombe Milk Project

Most development organisations have traditionally used the Logical Framework Approach to design, monitor and evaluate development projects. We depart from this mechanical view and join an emerging literature that recognises project complexity as well as the importance of institutional dynamics. The article deals with an evaluation of a multi-sectoral project in Tanzania, centred on the production, selling and distribution of milk in schools. By combining qualitative and quantitative methods and using the capability approach as conceptual framework, we analysed the project’s effect on selected functionings, entitlements and agency of the different stakeholders. We found a positive effect on nutrition knowledge, farmers’ earnings and milk production, and an interesting unintended outcome of the project, an increase in children’s school attendance. However, an in-depth institutional analysis reveals problems in the institutional setting and in the relationships between stakeholders that undermine a sustainable human development process.

Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa

Small-scale pilot projects have demonstrated that integrated population, health and environment approaches can address the needs and rights of vulnerable communities. However, these and other types of health and development projects have rarely gone on to influence larger policy and programme development. ExpandNet, a network of health professionals working on scaling up, argues this is because projects are often not designed with future sustainability and scaling up in mind. Developing and implementing sustainable interventions that can be applied on a larger scale requires a different mindset and new approaches to small-scale/pilot testing. This paper shows how this new approach is being applied and the initial lessons from its use in the Health of People and Environment in the Lake Victoria Basin Project currently underway in Uganda and Kenya. Specific lessons that are emerging are: 1) ongoing, meaningful stakeholder engagement has significantly shaped the design and implementation, 2) multi-sectoral projects are complex and striving for simplicity in the interventins is challenging, and 3) projects that address a sharply felt need experience substantial pressure for scale up, even before their effectiveness is established. Implicit in this paper is the recommendation that other projects would also benefit from applying a scale-up perspective from the outset.

Can translational medicine bring us out of the R&D wilderness?

After 50 years of wandering among new discovery technologies and a worrying antiquated development process, the research and development (R&D) enterprise may finally have found a way out of its wilderness through the auspices of translational medicine. For that to happen, a number of problems have to be confronted. Most prominent is the traditional problem credited with giving rise to translational medicine - the lack of a feedback loop from bench to bedside. However, there are equally significant roadblocks to be confronted at every turn along the R&D pathway, from basic research through discovery and preclinical testing and, finally, into the clinic. Translational medicine is now beginning to encompass other powerful and promising innovations such as personalized medicine, bioinformatics, advanced imaging and biomarkers to help move beyond these roadblocks. Although translational medicine has attracted significant financial support in recent years, the economics of the movement are still challenging, as public and private sector funding are both difficult to come by due to the economic downturn. Some of the dearth of monies has been redressed by foundations and public-private partnerships, which combine resources and, hence, divide the risk to the benefit of all. More recently, the inherent tension among the traditional roles of 'big pharma', biotechs and the public sector, which had waned somewhat in the wake of the Bayh-Dole legislation in the USA, has re-emerged owing to the furor over conflicts of interest. Translational medicine may help alleviate these tensions by its example of successful precompetitive collaboration, such as the Predictive Safety Testing Consortium and its effective use of project management techniques in multidisciplinary, multiphasic, multisectoral projects to bring the discipline necessary for the efficient functioning of consortia. Changing a research paradigm that has remained substantially unchanged for half a century will require considerable time, money and effort. However, there is reason to be optimistic that translational medicine is the right solution for the right problem at the right time.

The Akropong approach to multi-sector project planning

We introduce an approach to cross-sector project planning developed in the context of a climate change adaptation strategy being carried out in Ghana. The approach, which uses a simplified cross-impact approach, should be applicable in many cross-sector or cross-disciplinary studies in which the work is carried out by sector or discipline-specific teams.

Releasing the True Potential: Adolescent Participation in Mongolia

Mongolia's adolescents are growing up in a world that is totally different from the one in which their parents became adults. Traditional expectation is that young people remain silent in the presence of an adult and to express their opinion or challenge those of their elders is the height of discourtesy. At the turn of the century, for the first time, the Mongolian government and the United Nations agencies focused attention on the participation and development rights of adolescents. Adolescents' perception of their own needs became the blueprint for “Improving the Outlook of Mongolian Adolescent Girls and Boys,” an extensive multi-sectoral project involving a variety of separate but linked initiatives in 17 rural and urban project sites. This report examines the process and quality of adolescent participation within the context of the project, at each stage of the project cycle, and the effect of participation on the adolescents themselves and on their families, their schools, their communities, and government policy.

Building sustainable wastewater reuse in Jordan

Jordan's population is projected to reach 6.5 million by 2010. Limited water does not meet present or projected demands, groundwater levels are dropping, and industrialization is increasing pressure on water resources and the environment. The agricultural sector alone uses approximately 70% of total water resources. Wastewater represents a resource that can help fill Jordan's gap between supply and demand. While approximately 80% of the over 80 MCM of wastewater/yr is currently reused, only a fraction is formalized with permitting and adherence to reuse guidelines. The Jordanian government seeks to embrace reclaimed resources in national water resources planning through recognized/regulated reuse implementation activities. A multi-sectoral project is being performed to help reach this goal in Jordan and worldwide, sharing lessons learned in increasing access to reused water, and involving performance of four demonstration projects with an aim toward developing replicable operational conditions that support sustainability/enhance expansion of treated wastewater reuse in Jordan.

A STUDY ON FORMULATION OF MULTI-SECTOR PROJECT FOR IMPROVEMENT OF WATER RELATED ENVIRONMENT IN URBAN AREAS OF DEVELOPING COUNTRIES

This paper presents a systematic method of formulating an effective multi-sector project for improving the water-related environment in the urban areas of developing countries. The previous studies argued that the most important factor for formulating a multi-sector project is to understand the complicated problems systematically, since most of the water-related environment problems are a result of combination of problems in various sectors. In this paper, the problem-tree analysis method of Project Cycle Management is adopted and applied with a proper modification to find out the structure of the problem. To utilize the method efficiently, the project formulation stage is classified into the following three steps, “finding out the water-related environmental problems”, “identifying the problem to be solved and its cause”, and “selecting the sector in question and extracting project components”. The proposed method enables 1) to draw up the structure of water-related environmental problems visually, 2) to set up the project's components and target properly and 3) to select the sector to be involved logically.

A model for the planning of new settlement projects

A comparative study of new settlement projects revealed a common failure to realize full employment potentials owing to reliance on agriculture alone. The present study proposes a method of increasing employment potentials, using a simulation model of multisectoral projects. The model comprises 18 prototypes, based on different combinations of ecological conditions, number of settlers and level of income. Employment potentials in industry and services are calculated by applying appropriate ‘multiplying-factor’ coefficients to agricultural employment capacity. The results indicate that greater employment potentials are realized in multisectoral projects. Moreover, efficiency of employment generation increases with the increase in the level of planned income and the size of the project, as indicated by greater employment density per unit of cultivated area and lower investment per employment unit.

THE ROLE OF AGRICULTURE IN INTEGRATËD RURAL DËVELOPMENT PROJECTS: THE EXPERIENCE OF THE WORLD BANK

SUMMARYA deliberate shift in the World Bank's policy over the past six years has resulted in a widening and deepening of lending for agriculture and, in particular, for rural development programs, defined as programs with an antipoverty focus, targeted toward benefiting small farmers. The new lending strategy elicited new types of projects and is confronted with new economic, sociological, institutional and technological problems. Additional research is needed to examine the conceptual framework and the operational experience of rural development projects and for designing monitoring and evaluation systems for such programs.RésuméAu cours des six dernières années, la Banque Mondiale, ayant modifyéRural Development Sector Policy Paper, World Bank; February 1975. sa politique, a accru de façon sensible ses prêts au monde agricole notamment dans le cadre de programmes de développement rural orientés vers les petits agriculteurs dans le but de réduire leur pauvretea. Si cette nouvelle stratégie a fait naître de nouveaux types de projets, on se trouve confronté maintenant à de nouveaux problèmes ?ordre économique, sociologique, institutionnel et technologique. En conséquence, le besoin ?un programme de recherche complémentaire se fait sentir pour examiner la conception mecme de ces programmes de développement rural, lcaron;expdrience qui s'en dégage et pour concevoir des systèmes de suivi opérationnel et ?eavaluation adaptés à ce genre de programmes.ZUSAMMENFASSUNGEin Umdenken in der Politik der Weltbank hat in den vergangenen sechs Jahren zu einer Erweiterung und Vertiefung der Kreditvergabe für ländwirtschaftliche und insbesondere für ländliche Entwicklungs‐programme geführt. Programme, in deren Brennpunkt die Bekampfung der Armut stehen, und die auf eine Förderung von Kleinbauern zielen. Die neue Strategic der Kreditvergabe bedingte neue Projekt‐formen und stieß auf neue ökonomische, soziologische institutionelle und technologische Probleme. Ergänzende Forschungsarbeit ist notwendig, um einerseits die konzeptionellen Rahmenbedingungen und die Erfahrungen bei der Durchführung ländlicher Entwicklungs‐projekte zu untersuchen und andererseits Systeme zur Planung, Über‐wachung und Bewertung solcher Programme zu entwickeln.