National Action Research Articles

An Indonesian way of P/CVE and interpreting the whole-of-society approach: lessons from civil society organisations

ABSTRACT In 2016, The United Nations (UN) issued the Plan of Action to Prevent Violent Extremism that prescribes member states to adopt a National Action Plan (NAP) to combat violent extremism through whole-of-government and whole-of-society approaches. A key aspect of the whole-of-society approach is to involve civil society organisations (CSOs). The collapse of the New Order regime in Indonesia, coupled with shifting global focus to P/CVE agendas, granted them wide latitude to pursue their objectives and the right environment to flourish. However, the mushrooming of P/CVE CSOs in Indonesia exposes the country to challenges such as uncoordinated programmes and competition. This article argues that these experiences prompted Indonesia to interpret the concept of the whole-of-society approach and to formulate a common NAP for relevant stakeholders to refer to. The NAP provides an official categorisation to assess the implementation of P/CVE programmes and identify required interventions. It also encourages all relevant stakeholders in the field to develop a unified database and a formal working mechanism among them. The availability of such regulations and mechanisms is critical to enhancing the impact of P/CVE initiatives, including the contributions of CSOs.

WHO Guidelines on Mental Health at Work

The World Health Organization (WHO) published the "Guidelines on mental health at work" in September 2022. WHO developed the guidelines in accordance with WHO standards. The summary of this guideline was translated into German by the team of the WHO Collaborating Center for Evidence-based Medicine at the University for Continuing Education Krems (Austria) for use in German-speaking countries. An estimated 15+% of working-age adults have had some mental disorder at some point of time in their lives. This can lead to impaired capacity to work, resulting in reduction in productivity and performance, and ability to work safely, or in difficulties in retaining their jobs or obtaining gainful employment. The guidelines contain 12 recommendations. These provide evidence-based global public health guidance on organizational interventions, manager and worker training, and individual interventions for the promotion of positive mental health and prevention of mental health conditions, as well as recommendations on returning to work following absence associated with mental health conditions and gaining employment for people living with mental health conditions. Through the provision of these WHO recommendations, it is anticipated that the guidelines will facilitate national and workplace-level actions in the areas of policy development, service planning and delivery in the domains of mental and occupational health.

The role of health policy in the prevention of venous thromboembolism in the UK National Health Service—Learning from the past, looking to the future

Venous thromboembolism is the third most common cause of cardiovascular death globally and many diagnoses are preventable. The UK NHS has led international efforts to reduce VTE, particularly hospital-associated VTE, through coordinated national policy action and world-leading research. Despite this, VTE remains an important cause of morbidity and mortality in the UK, as underlined by the recent COVID-19 pandemic. Future reductions in VTE incidence/deaths will require progress on several fronts: a better understanding of case mix; revisiting VTE risk assessment, focussing on thromboprophylaxis failure and improving awareness of VTE amongst clinicians and the public. Changes to healthcare delivery, with care increasingly delivered outside of hospital, alongside changing disease patterns, including the rise in obesity, have huge implications for VTE and will dramatically alter prevention. The UK, with its nationalised healthcare model and long history of policy action on VTE, provides a unique lens through which to study past successes and future priorities for VTE prevention.

Implementation of an antibiotic resistance surveillance tool in Madagascar, the TSARA project: a prospective, observational, multicentre, hospital-based study protocol

IntroductionAntimicrobial resistance (AMR) has become a significant public health threat. Without any interventions, it has been modelled that AMR will account for an estimated 10 million deaths annually by 2050,...

The Dynamics of Cameroon’s Major National Dialogue and Attempts at Resolving the Anglophone Crisis since 2016: Understanding National and International Responses

The Dynamics of Cameroon’s Major National Dialogue and Attempts at Resolving the Anglophone Crisis since 2016: Understanding National and International Responses

Factors Associated with Inappropriate Use of Antibiotics Among Animal Health Professionals in Selected Districts of Rwanda, 2021

BackgroundAntibiotic resistance is a global health concern. Humans can acquire antibiotic resistance through human-to-human transmission, from the environment, via the food chain, and through the contact with animals. The National Action Plan on antimicrobial resistance 2020–2024 highlights the prudent use of antibiotics in veterinary activities as the key element in keeping antibiotics effective. We determined the factors associated with misuse of antibiotics among animal health professionals in Rwanda.MethodsThis was a cross-sectional study that enrolled animal health field professionals from five districts, where stratified random sampling was used to select one district by each province of Rwanda. Structured questions were used during face-to-face interviews. The misuse of antibiotics was defined as the use of antibiotics for reasons other than treatment, the non-completion of required courses, or the use of a high dose (i.e., an overdose) of antibiotics. We collected socio-demographic data of respondents, as well as elementary knowledge and perceptions on veterinary antibiotics and antibiotic resistance. A backward stepwise logistic regression model was used to identify the factors that were predictive of the inappropriate use of antibiotics.ResultsThere were 256 respondents to the survey. Of those, 198 were male and 58 were female. Almost three quarters of respondents (n = 174/256; 68%) reported the misuse of antibiotics at least once in the previous 12 months. The final logistic regression analysis identified the following factors to be predictive of antibiotics misuse: aged ≤ 24 years (aOR 0.92; 95% CI [0.88, 0.96]; p < 0.001); low trust in veterinary antibiotics available in the local market (aOR 8.45; 95% CI [4.18, 17.07]; p < 0.01), insufficient knowledge about basic understanding of antibiotics and antibiotic resistance (aOR 2.78; 95% CI [1.38, 5.58], p < 0.01) and not acquiring any continuing education (aOR 1.97; 95% CI [1.02, 4.19]; p = 0.04).ConclusionsThis study identified inadequate perceptions of proper antibiotic use among animal health professionals. There is a need for continuous education on appropriate antibiotic use among animal health professionals to lessen the negative impact of antibiotic resistance on public health security.

Disrupting the Transitional Justice Circuit: Everyday Transformative Gender Justice in Colombia

ABSTRACT There is abundant criticism towards mainstream transitional justice (TJ) scholarship and practice. As an alternative, we propose an everyday transformative gender justice framework that brings socioeconomic, transformative gender, and the everyday to the centre of TJ. Using empirical data gathered in Colombia we make two arguments. First, women-led activism privileges an everyday, localised, transformative, and gender transformative understanding of TJ. Second, they interact with local, national, and international actors, which enhances their transformative potential to disrupt broader peace and justice circuits. Our findings suggest that part of the transformative potential of TJ lies in the work of localised emancipatory initiatives.

Assessment of the Implementation of Pakistan's National Action Plan on Antimicrobial Resistance in the Agriculture and Food Sectors.

The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan's first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017-2022. To improve subsequent iterations, we assessed the implementation of Pakistan's NAP in the agrifood sectors (NAPag) in October 2022, using the Progressive Management Pathway on AMR tool developed by the Food and Agriculture Organization of the United Nations (FAO). The assessment tool addressed four crucial focus areas of the NAPag: governance, awareness, evidence, and practices. Each focus area contains multiple topics, which involve four sequential stages of activities to progressively achieve systematic management of AMR risk in the agrifood sectors. High-level representatives of the NAPag stakeholders provided information for the assessment through pre-event documentary review and workshop discussions. The assessment results showed that Pakistan's NAPag had an overall moderate coverage (59%) of the anticipated activities. Gaps were particularly notable in strengthening governance, good practices, and interventions in non-livestock sectors. Furthermore, only 12% of the evaluated activities were fully executed and documented, consistently remaining at the planning and piloting stages in the livestock sector across all the examined topics. Insufficient attention to non-livestock sectors, inadequate regulation and enforcement capacity, and resource constraints have hindered scalable and sustainable interventions under the current plan. This assessment provides valuable insights to strengthen the inclusiveness and contribution of the agrifood sectors in the next NAP iteration. In the short-to-medium term, strategic prioritization is necessary to optimize the use of limited resources and target the most critical gaps, such as improving awareness among key stakeholders and fortifying regulations for prudent antimicrobial use. In the long term, integration of AMR into the country's broader health, development, and agricultural transformation agendas will be needed to generate sustainable benefits.

Linking climate change adaptation and public health: perspectives of Norwegian policymakers.

To explore the perspectives of selected Norwegian climate and health policymakers working at national and municipality level regarding how health is accounted for in climate change adaptation plans. Semi-structured digital interviews were conducted with representatives from eight municipalities participating in a national network for climate change adaptation, one political unit and five national public administrations working in climate, health, environment, preparedness, and civil protection. Municipalities coordinate the development of climate change adaptation plans with support from key national actors. Although municipalities were experienced in preparing for extreme climate events and securing infrastructure, limited consideration was given to health in the climate change adaptation work. Such integration was hindered by lack of resources and knowledge regarding what to do, and lack of collaboration between municipality sectors. To connect climate change adaptation and health better, the representatives suggested providing evidence-based information regarding health impacts of climate change, developing concrete tools including warning systems, and implementing regional, national, and international projects to map the impact of climate change and raise capacity. The representatives called for more stringent national guidelines for the integration of health in climate change adaptation, and pinpointed that lessons learnt from the COVID-19 pandemic will enable municipalities to be better prepared and more adaptable in the future. Governmental authorities should provide more concrete guidance regarding the integration of health in climate change adaptation plans. Public health authorities have a central role to play in supporting such endeavours.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019.

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts. Cross-sectional analysis of 2019 Veterans' Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing. In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition. More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.

The Fragmented Picture of Antimicrobial Resistance in Kenya: A Situational Analysis of Antimicrobial Consumption and the Imperative for Antimicrobial Stewardship.

Antimicrobial resistance (AMR) jeopardizes the effectiveness of essential antimicrobial agents in treating infectious diseases. Accelerated by human activities, AMR is prevalent in Sub-Saharan Africa, including Kenya, due to indiscriminate antibiotic use and limited diagnostics. This study aimed to assess Kenya's AMR efforts through a situational analysis of policy efficacy, interventions, and implementation, culminating in recommendations for strengthening mitigation. Employing two methodologies, this study evaluated Kenya's AMR endeavors. A systematic scoping review summarized AMR dynamic, and an expert validated the findings, providing an on-the-ground perspective. Antibiotic resistance is driven by factors including widespread misuse in human medicine due to irrational practices, consumer demand, and substandard antibiotics. Heavy antibiotic use in the agricultural sector leads to contamination of the food chain. The National Action Plan (NAP) reflects a One Health approach, yet decentralized healthcare and funding gaps hinder its execution. Although AMR surveillance includes multiple facets, diagnostic deficiencies persist. Expert insights recognize proactive NAP but underscore implementation obstacles. Kenya grapples with escalating resistance, but commendable policy efforts exist. However, fragmented implementations and complexities persist. Addressing this global threat demands investment in healthcare infrastructure, diagnostics, international partnerships, and sustainable strategies.

Gender mainstreaming in the Japan Self‐Defense Forces

AbstractThe issue of “gender integration” within the military organization has long been a major research topic in military sociology. In the last two decades, however, specific topics such as “gender mainstreaming,” “diversity management,” and “diversity and inclusion” have pervaded sociological studies on military organizations. In this article, I examine the current state of gender integration in the Japan Self‐Defense Forces (JSDF), focusing on efforts to promote gender mainstreaming. In particular, following the National Action Plan to implement the United Nations Security Council Resolution 1325 was formulated in 2015, the Ministry of Defense issued the JSDF Female Personnel Empowerment Initiative in 2017, in which previous challenges for career development of female SDF personnel were to be removed by making virtually all job categories available for women including combat pilot, missile boat crew, and tank driver. While the number and ratio of female personnel have increased and their prospects of career development have substantially improved in the last few years, work–life conflict and sexual/power harassment remain to be challenging issues for the retention of female personnel. Due to the deep‐rooted male‐dominant organizational culture of the military organization, further organizational challenges remain for JSDF to shift its overarching human resource management paradigm from “Diversity 1.0” to “Diversity 2.0,” with the strong commitment of top leaders to innovate organizational culture.

Problematizing “Security” in Citizen Security: A feminist security studies critique of Mexico's “feminist” foreign policy and women, peace and security projects

AbstractThis article problematizes the concept of “security” within the concept of “citizen security” employed by Mexico, through a feminist security studies critique. Considering feminist security studies critiques that often see security as ultimately tied to militarization, regardless of the security referent, this article shows how this problem surfaces in Mexico's National Action Plan for Women, Peace, and Security and in the claim that Mexico has adopted a feminist foreign policy. Not only do these initiatives largely ignore high rates of femicide and other forms of state and nonstate violence in Mexico, but they are also reproductive of violence, particularly militarized violence, in their attachments to security. The article delves into the literature on how Mexico and other states domestically inimical to feminist movements have instituted national action plans that militarize the women, peace, and security agenda, embraced feminist foreign policies as they have further militarized, or both, often promulgating plans with little or no input from civil society. Mexico is revealed as a Janus‐faced example where seemingly liberal feminist values are promoted abroad but are not implemented at home. Thus, the nation is refashioning itself as a “good global citizen” at the expense of implementing and expanding citizen (and noncitizen) rights and protections within its borders.

UPAYA KOLABORATIF THE UNITED NATIONS OFFICE ON DRUGS AND CRIME (UNODC) DAN PEMERINTAH INDONESIA DALAM MENANGGULANGI HIV/AIDS DI INDONESIA

This article aims to describe efforts to deal with HIV/AIDS in Indonesia through collaboration between The United Nations Office on Drugs and Crime (UNODC) and the Indonesian Government in the 2017-2020 Indonesia Country Program. The method used in this research is a qualitative method and literature study as a data collection technique. Meanwhile, international organization theory and the concept of Human Security are used as theoretical foundations. The results of this research indicate that efforts to control HIV/AIDS in Indonesia by the Indonesian Government in collaboration with UNODC are the right steps, considering that HIV/AIDS is a disease that has an impact on human health security. UNODC assists Indonesia in achieving its goals and interests through the Indonesia Country Program by designing a systematic work plan to discuss and contribute to the creation of a National Action Plan (RAN) to overcome the spread of HIV/AIDS among prisoners and convicts in Indonesia

From Local Energy Communities towards National Energy System: A Grid-Aware Techno-Economic Analysis

Energy communities are key actors in the energy transition since they optimally interconnect renewable energy capacities with the consumers. Despite versatile objectives, they usually aim at improving the self-consumption of renewable electricity within low-voltage grids to maximize revenues. In addition, energy communities are an excellent opportunity to supply renewable electricity to regional and national energy systems. However, effective price signals have to be designed to coordinate the needs of the energy infrastructure with the interests of these local stakeholders. The aim of this paper is to demonstrate the integration of energy communities at the national level with a bottom–up approach. District energy systems with a building scale resolution are modeled in a mixed-integer linear programming problem. The Dantzig–Wolfe decomposition is applied to reduce the computational time. The methodology lies within the framework of a renewable energy hub, characterized by a high share of photovoltaic capacities. Both investments into equipment and its operation are considered. The model is applied on a set of five typical districts and weather locations representative of the Swiss building stock. The extrapolation to the national scale reveals a heterogeneous photovoltaic potential throughout the country. Present electricity tariffs promote a maximal investment into photovoltaic panels in every region, reaching an installed capacity of 67.2 GW and generating 80 TWh per year. Placed in perspective with the optimal PV capacity forecast at 15.4 GW peak at the national level, coordinated investment between local and national actors is needed to prevent dispensable expenses. An uncoordinated design is expected to increase the total costs for residential energy systems from 12% to 83% and curtails 48% of local renewable electricity.

An Assessment of the Current Level of Implementation of the Core Elements of Antimicrobial Stewardship Programs in Public Hospitals in Ghana.

Introduction: Antimicrobial resistance (AMR) is becoming a threat to global public health. Antimicrobial stewardship (AMS) program (ASP) is one of the 5 strategic areas in the Ghana National Action Plan to fight this menace. Assessment of the core elements of ASP in a hospital setting has been identified as a pragmatic way of identifying the barriers and facilitators for its effective implementation. Method: The World Health Organization's toolkit for assessment of the 7 core elements of ASP in hospitals in low and middle income countries was used for this situational analysis of public hospitals in 2 regions of Ghana. The core elements included leadership commitment, accountability and responsibility, pharmacy expertize, AMS actions and interventions, education and training, and periodic monitoring and surveillance. Data collected using a checklist were imported into STATA version 14 for descriptive and bivariate analyses. Results: 15 public hospitals were assessed with the toolkit. Most of them were primary health care facilities (n = 12, 80.0%), had bed capacities between 100 and 199 beds, less than 50 medical doctors (n = 12, 80.0%), less than 5 pharmacists (n = 10, 66.7%), and between 100 and 199 nurses. Performances in 4 out of the 7 core elements were most deficient and they included leadership commitment, pharmacy expertize, AMS actions (interventions) implemented, monitoring and surveillance of antibiotic use, and bacteria resistance rates. Pharmacist-led ASPs were also found to be associated with their formal training on AMS. Key barriers identified included lack of skilled human resources, lack of available time for AMS-related duties and poor laboratory infrastructure. Conclusion: There was sub-optimal performance for almost all the core elements of ASP in the public hospitals in Ghana hampered mostly by lack of skilled human and financial resources. Pharmacists must be empowered through formal training and certificate programs in infectious disease management and AMS principles and strategies to enhance their contribution toward ASPs in hospitals. The results from this study should encourage nationwide assessment of ASPs across hospital settings in Ghana to better evaluate the level of their implementation and address potential barriers to guide AMS policies and ASP strategy development toward the fight against AMR.

A Descriptive Analysis of Therapeutic Drug Monitoring In India

Therapeutic drug monitoring (TDM) has evolved into therapeutic drug management throughout the past three to four decades, becoming a crucial facet of precision medicine. Even though India has one of the fastest-growing economies in the world, TDM is not widely used there. At the moment, it is restricted to a small number of teaching hospitals and academic medical institutes. Other therapeutic domains, such anticancer, antifungal, antibacterial, and antitubercular medications, have shown considerable promise to enhance patient outcomes in Indian settings, aside from immunosuppressive pharmaceuticals. The population of this subcontinent is unique in terms of the importance of TDM due to factors like the higher prevalence of nutritional deficiencies, tropical diseases, the widespread adoption of alternative medicines, unlike pharmacogenomics, and the scarcity of population-specific data on the therapeutic ranges of multiple drugs.TDM has not gotten the interest it merits in India, despite its vast applicability and influence on clinical science. This study aims to present a SWOT (strength, weakness, opportunity, and threats) analysis of TDM in India so that suitable measures for promoting TDM growth can be envisaged. Forming a collaborative group with all the stakeholders—including TDM experts, physicians, and the government—and coming up with a National Action Plan to support TDM are urgent needs. To determine the country's TDM focus areas, nodal TDM facilities should be formed, and pilot programmes should be launched. Capacity development and awareness rising are also important steps towards integrating TDM into traditional clinical practice.

The Growth Opportunities for Nigeria in Joining the African Continental Free Trade Area.

This Article examines the African Continental Free Trade Area (AfCFTA), focusing on its inception, goals, challenges, and specific implications for Nigeria. Africa, with abundant natural resources and cultural diversity, faces hindrances like poor infrastructure and governance, limiting intra-African trade. Established in 2018, AfCFTA aims to create a competitive single African market by eliminating tariffs and barriers. AfCFTA objectives span tariff elimination, customs harmonization, dispute resolution, and cooperation on technical barriers. Challenges include infrastructure gaps, non-tariff barriers, economic diversity, competition adjustments, informal trade, political instability, capacity constraints, and financing issues. Mitigating these requires strategies like infrastructure development, trade facilitation, capacity building, and harmonizing standards. Nigeria, as Africa's largest economy, could benefit from AfCFTA by accessing cheaper goods. However, implementation faces delays due to unmet trade requirements. The National Action Committee outlines pillars for effective implementation, emphasizing institutional development, export growth, improved trade facilitation, and infrastructure development. Despite Nigeria's delay, the upcoming Guided Trade Initiative in October 2023 is anticipated to accelerate its participation in AfCFTA, fostering economic growth and trade relations within the continent. Keywords: Global trade, globalization, AfCFTA, Trade Block, Commerce.

“Kuteteza”: A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi

Background The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. Data suggest that the Malawi epidemic developed largely in urban settings, but the extent of rural spread – exposing older adults in particular – is unclear. This concern led us, to develop the ‘Kuteteza’ partnership project: a community-based Public Health intervention involving the shielding of older adults and additional strategies to mitigate COVID-19 impacts in rural Malawi. We now present the results of a realist project evaluation. Methods Clinicians, Public Health professionals, and researchers collaborated with government and district level staff in two Malawi districts. After engagement with local structures, willing older adults (&gt;60 years) and their communities made arrangements for supported 'shielding'. Masks, handwashing stations, and soap were also provided, and government partnerships allowed additional support for vulnerable groups. Finally, context-responsive community engagement reinforced COVID-19 prevention during peak risk periods. Our realist evaluation included collation of anonymised descriptive data and qualitative structured observations and focus groups – involving community members and volunteers – in each setting. Results The project involved 25 villages. Multi-level stakeholder engagement was pivotal in developing and establishing the work, and strong District Health Office support was integral to implementation. Team members contributed to national meetings, aligning the project with national guidance and stakeholder actions. Established partnerships with relevant ministries resulted in the incorporation of shielding in the Malawi COVID-19 response plan. In Kuteteza villages, handwashing stations and soap were used, and there was awareness of COVID-19 prevention measures. Further experiences and evaluation results are presented, including learning points for future outbreak responses. Conclusions Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project raised awareness and supported populations at a critical time in the pandemic. These approaches can be incorporated in future epidemic and emergency responses.

ISAF and European military transformation: German, Swedish and French counterinsurgency in Afghanistan, 2003–2014

This article examines the role of a subset of European militaries in responding to the Afghan insurgency during their deployment as part of the International Security Assistance Force (ISAF). While part of a multinational coalition, their heterogeneous military transformation was crucial to fighting the insurrection and confronting American pressure. In comparing the counterinsurgency innovations of Germany, Sweden, and France, we find that Germany acted reluctantly, Sweden largely emulated American doctrine, and France became a counterinsurgency pioneer. We argue that these developments took time and were accompanied by conflicts within ISAF and between the respective national military and political leaderships.