Opinions Of Key Stakeholders Research Articles

Designing an interoperable patient portal to augment an Advanced Nurse Practitioner service for Children with hydrocephalus

BackgroundChildren's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services. AimThe aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus. MethodsInterviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using Braun and Clarke's (2006) framework. ResultsFour key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus ConclusionsThe availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from. Study RegistrationThis study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland Twitter AbstractA study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus

"Exploring the Process and Perceptions of Noise Conflicts Related to a Geothermal Project. A Case Study of Szeged, Hungary "

The use of renewable energy, including geothermal energy, is essential. Hungary stands out for its remarkable geothermal potential. However, these investments often lead to noise pollution, causing social conflicts between the local population and developers. This research presents a case study of a geothermal district heating renovation project in Szeged, Hungary. The study explores public perceptions and social conflicts related to the geothermal heating renovation, focusing on noise impacts. Local media articles reflect public perspectives, while opinions of key stakeholders (politicians, service providers) offer a broader view of geothermal drilling and its noise impacts. The study examines Szeged residents’ knowledge about the ongoing drilling, its benefits, and the conflicts it entails, particularly noise pollution. The empirical survey employs both quantitative and qualitative methods, including a questionnaire survey and online media analysis. Results show that the public lacks sufficient information about geothermal drilling and its noise impact, whilst online media coverage is unclear. Residents often confuse it with other developments, which neither media experts nor the project owner adequately clarify. Survey respondents provided a complex interpretation of noise impacts, mostly accepting the project but questioning why it was in their immediate neighbourhood and why drilling occurred at night. Inconsistent information emerged as a main problem, revealed through content analysis and compared with questionnaire results, highlighting a general issue of unawareness. Media analysis showed opportunities for public comment and consultation, but communication was often unsuccessful due to local residents’ lack of interest. Project organizers attempted to provide information through various platforms, but local media often lacked clear information, causing confusion between past and current geothermal projects and a lack of understanding of the development’s reasons and site selection criteria. Overall, there was a willingness to understand the problems associated with drilling, but this was only partially achieved due to inadequate communication.

Assessing Needs and Perceptions of Research Participation in Pediatric-Onset Multiple Sclerosis: A Multistakeholder Survey

BackgroundPatient-powered research networks (PPRNs) for autoimmune disease are widely used in the adult population to recruit patients and drive patient-centered research, but few have included pediatric patients. We aimed to characterize viewpoints regarding research needs and participation in pediatric-onset multiple sclerosis (POMS) via a PPRN-disseminated survey. MethodsThis is an exploratory, cross-sectional study. The study period was February 1, 2022, to February 9, 2023. Three questionnaires were disseminated to (1) patients with POMS (PwPOMS), (2) caregivers of PwPOMS (C-PwPOMS), and (3) health care providers/researchers in POMS (HR-POMS). ResultsA total of 88 participants were included for analysis; 44% (n = 39) were PwPOMS, 42% (n = 37) were C-PwPOMS, and 14% (n = 12) were HR-POMS. Some PwPOMS (18%) and C-PwPOMS (9%) expressed research hesitancy, but more, 69% of PwPOMS and 68% of C-PwPOMS, were interested in research participation. Nevertheless, less than half of PwPOMS (38%) and C-PwPOMS (38%) reported previous research involvement. HR-POMS reported difficulties in funding (100%) and recruiting participants (58%). PwPOMS (67%), C-PwPOMS (62%), and HR-POMS (67%) were open to future involvement in PPRNs. ConclusionsParticipants with POMS in this study expressed strong interest in research involvement but also expressed participation hesitancy, which may contribute to recruiting challenges expressed by researchers. Although the exploratory design limits generalizability to the larger POMS population, this study shows PPRNs are well-suited to soliciting attitudes and opinions of key stakeholders in POMS. Future studies utilizing PPRNs for POMS should prioritize diverse, representative cohorts and focus on understanding and mitigating issues hindering research participation.

Perceived climate change risk and global green activism among young people

In recent years, the increasing number of natural disasters has raised concerns about the sustainability of our planet’s future. As young people comprise the generation that will suffer from the negative effects of climate change, they have become involved in a new climate activism that is also gaining interest in the public debate thanks to the Fridays for Future (FFF) movement. This paper analyses the results of a survey of 1,138 young people in a southern Italian region to explore their perceptions of the extent of environmental problems and their participation in protests of green movements such as the FFF. The statistical analyses perform an ordinal classification tree using an original impurity measure considering both the ordinal nature of the response variable and the heterogeneity of its ordered categories. The results show that respondents are concerned about the threat of climate change and participate in the FFF to claim their right to a healthier planet and encourage people to adopt environmentally friendly practices in their lifestyles. Young people feel they are global citizens, connected through the Internet and social media, and show greater sensitivity to the planet’s environmental problems, so they are willing to take effective action to demand sustainable policies from decision-makers. When planning public policies that will affect future generations, it is important for policymakers to know the demands and opinions of key stakeholders, especially young people, in order to plan the most appropriate measures, such as climate change mitigation.

Examining the place of the female condom in India’s family planning program: A qualitative investigation of the attitudes and opinions of key stakeholders in Pune, India

BackgroundWith overpopulation contributing to the depletion of planetary resources, the high rates of unintended pregnancies in India are a cause for concern. Despite the free supply of contraception options within India’s national family planning initiatives, women are generally offered hormonal options as temporary spacing methods. However, female condoms, a much neglected but potent woman initiated, non-hormonal multipurpose prevention device, are yet to be considered for inclusion in India’s contraceptive cafeteria. Thus, we aim to examine the place of female condoms among the contraceptive options, by analysing the perceptions of key stakeholders regarding its advantages and disadvantages, along with their opinions on how female condoms should be promoted.MethodsWe used purposive sampling to recruit and interview potential users and dispensers of the female condom. The interview participants visited or worked at family planning clinics in Pune at Smt. Kashibai Navale Medical College and General Hospital (SKNMC-GH), its urban and rural outreach clinics, and at Saheli (a non-governmental organisation for female sex workers). We conducted semi-structured interviews and coded our data inductively.ResultsWe interviewed 5 rural women, 20 urban women (including 10 female sex workers), 5 male partners of female sex workers, and 5 family planning healthcare providers. Nearly half (12/25) of the women we interviewed, said that they were eager to use female condoms in the future. Many participants perceived female condoms to be an instrument to empower women to be in control of their sexual and reproductive lives (15/35), and that it provided user comfort and confidence (4/35). Their perceived disadvantages are that they are relatively more expensive (6/35), users have limited experience (9/35), and women who buy or use them may be stigmatised and feel embarrassed (4/35). Yet, nearly three-quarters of potential users (21/30) and most healthcare providers (4/5), were confident that female condoms could become popular following extensive promotional campaigns, interventions to improve availability and access, and initiatives to enhance the knowledge of female users.ConclusionsFemale condoms have garnered support from both users and dispensers and have the potential to be widely adopted in India if family planning initiatives which increase awareness, knowledge, and access are systematically undertaken as with other contraceptive options.

A Survey of Priority Livestock Diseases and Laboratory Diagnostic Needs of Animal Health Professionals and Farmers in Uganda

Background: Despite the investments made in veterinary diagnostic laboratory service delivery in Uganda, the scope and level of utilization remains low. This study aimed to determine the priority livestock diseases for which farmers and animal health professionals require veterinary diagnostic laboratory services, document the perceptions and opinions of key stakeholders on veterinary diagnostic laboratory services, and determine the factors that influence the delivery and utilization of animal disease diagnostic services in Uganda.Methods: A qualitative study approach involving a survey and key informant interviews was used to collect relevant data from four stakeholder groups: animal health workers, laboratory technologists and technicians, farmers, and key informants. The survey data were exported to excel, and descriptive statistics performed. The key informant interview recordings were transcribed, and thematic analysis performed.Results: The most reported diseases and conditions for which diagnostic services were needed were hemoparasites (including East Coast fever, anaplasmosis, babesiosis, and trypanosomosis), viral (including Foot and mouth disease, lumpy skin disease, rift valley fever, and papillomatosis), bacteria (including brucellosis, colibacillosis, anthrax, leptospirosis, and paratuberculosis) and protozoa diseases (coccidiosis), endoparasites (helminths), and mastitis. The most common diagnostic laboratory tests requested by clients, but laboratories were unable to provide included: rapid tests for contagious bovine pleuropneumonia, Foot and mouth disease, Newcastle disease, acaricide analysis, culture and antimicrobial sensitivity test, serology, and complete blood count. The most frequently reported challenges to providing diagnostic laboratory services were poor or lack of relevant equipment, insufficient or lack of supplies and reagents, high cost of reagents, inadequate or lack of laboratory staff to perform tests, and inadequate training of laboratory staff.Conclusions: This study highlighted the need to improve provision of laboratory diagnostic services to meet the prioritized diagnostic needs of farmers and animal health professionals. Increased intersectoral engagement and funding support from the private, industry, and government sectors is necessary to help address the observed challenges to provision of diagnostic laboratory services, including equipping of the laboratories, provision of supplies, and hiring and training of laboratory staff. Finally, the findings also suggest that the education of farmers and animal health workers on the value and benefits of laboratory diagnostic services may contribute to increase in sample submission and subsequent demand for diagnostic laboratory services.

Opinions of key stakeholders regarding the inpatient Individual Care Plan.

In Ireland, regularly reviewed Individual Care Plans (ICPs) for inpatients at all acute psychiatric inpatient units are a requirement of the Mental Health Act . In this study, we comprehensively evaluated and compared opinions of key stakeholders in relation to the ICP as a care delivery tool. We employed a descriptive survey design. Questionnaires were distributed to 123 stakeholders (patients and mental health professionals (MHPs)) to evaluate and compare opinions regarding the impact of the ICP in relation to healthcare delivery and health outcomes, and regarding the structure and frequency of use of the ICP. Ninety-eight stakeholders (80%) completed study questionnaires. Stakeholders (patients (58%) and MHPs (85%)) reported that the ICP assisted in healthcare delivery. However, different attitudes between groups were noted in relation to whether the ICPcontributed towards healthcare outcomes, with 64% of patients, but only 41% of MHPs reporting that the ICP positively contributed to mental healthcare outcomes. Some free-text comments described patient dissatisfaction with the role of the ICP for healthcare delivery, and MHP dissatisfaction that the ICP was time-consuming and did not significantly enhance standard patient care. Whilst the implementation of the ICP is generally viewed positively by both patients and MHPs, considerable dissatisfaction by MHPs was also noted with certain aspects of how the ICP was delivered in practice. Practical adjustments to the implementation of ICP in order to build more positive stakeholder experiences appear warranted and worthy of further research.

639 ENT Telephone Follow Up in The Era of Covid-19: A Retrospective Qualitative Analysis Utilising Semi structured focus groups

IntroductionCovid-19 and social distancing has triggered a seismic shift in clinical work especially during the first part of lockdown. This work looks to evaluate the experience and opinions of key stakeholders who took part in the process and use this to improve follow up in the future.Method3 Focus groups following the same semi structured format discussed key considerations in follow up in general, telephone follow up, key aspects in its delivery and how this could benefit the service provided to patients. The focus groups involved Juniors (registrar level doctors), Consultants and support staff (clinical and non-clinical).ResultsSeveral themes and subthemes were identified. Key points were that patients were universally in favour of telephone consultations; they find them convenient and enjoy not attending the hospital. All clinicians agreed that although Covid-19 lead us to review New patients via telephone this increased workload as they needed to attend later for an examination and felt it did not provide safe care.ConclusionsThere is certainly an increasing role for telephone follow ups in the wake of Covid-19 which can benefit ongoing patient care and aid in managing the departments follow up capacity. Further work is needed to review this.

Indoor Camping in Fortified Heritage Buildings: A New Way of Sustainable Tourism Valorization

Indoor camping is an innovative, sustainable model of accommodation, the least intrusive one in solid facilities. Its temporary tourism function demands almost no additional construction work, meaning no permanent modification of space is needed for tourism purposes. Fortifications and defence buildings are recognised as valuable cultural attractions and present an anthropogenic resource with potential for touristic valorisation, both as sightseeing facilities as well as accommodation facilities. This paper explores the connection between the requirements of heritage protection of fortifications and the requirements of the application of indoor camping in these fortifications. The purpose of this paper is to help conserve fortifications by providing funding for their maintenance with the application of this innovative accommodation model respecting the principles of sustainability and health and safety standards in post-Covid tourism. The goal is to provide a general framework that could reconcile tourism businesses on one side and conservators on the other. The main scientific contribution is summarised in the framework of adequate implementation of indoor camping in fortified buildings according to conservators’ requirements. The interview technique was used to assess this. The authors found that indoor camping can be a suitable accommodation model in fortified buildings. The key limitation of the model is based on the fact that an individual approach is necessary for every heritage building, as well as fortification, since they are unique. Therefore, each application of an indoor camping model should receive a proper conservators’ permit before the entrepreneurship venture. Furthermore, the opinions of key stakeholders were also investigated.

PP501 Inclusion Of Key Stakeholders’ Views When Developing A mHealth Assessment Tool: Focus Groups And Health Consensus Results

IntroductionThe Agency for Health Quality and Assessment of Catalonia (AQuAS) is developing an evaluation tool for mobile health (mHealth) solutions to be used by health technology assessment (HTA) agencies and evaluation experts. In order to have a practical and comprehensive tool taking into account the particularities and challenges of mobile interventions, we considered the views and opinions of key stakeholders. The objective was to present the final selection of general aspects (dimensions) to be assessed in the evaluation, as well as the specific items (criteria) to be included in each of these topics, as a result of different co-design approaches with health professionals, developers, hospital managers, HTA agencies and patients.MethodsA list of criteria used for health apps evaluation were drawn from a literature review. The initial list included eighty-nine criteria items grouped in nine domains. Those criteria and domains were discussed during four focus groups (FG). The importance of the criteria that were not considered as mandatory were later rated through a Delphi online sub-study, in a scale from one to six points, taking as consensus value when median value (median 6, Interquartile range, 0–1) was reached.ResultsFG reduced domains and criteria from nine to seven and from eighty-nine to thirty-three, respectively. Most mandatory criteria were related with security, user experience, and clinical effectiveness. Fifty-seven individuals (53.7% of 106 invited to participate) were registered in the online platform (50.1% women, 68.4% 35–64years old and 42.1% from HTA agencies). From fifty non-mandatory criteria under consensus, ten criteria reached consensus (most from solution's content and health problem covered domains) concluding with a 43/7 criteria/domain tool.ConclusionsInsights from main stakeholders on the content of the tool for mHealth assessment were considered through the FG and Delphi technique. The dimensions of security and privacy, clinical effectiveness, solutions’ content, technological aspects, users’ experience and costs were considered mandatory. The dimension related to the impact on the organization was appraised as a secondary domain for evaluation. A workshop with AQuAS research team and HTA external researchers will help to define: the assessment methods (type of instrument, dichotomous responses and/or Likert scales) for the evaluation and the format and dimension's weights of the final design of the tool.

A Simulated Graphical Interface for Integrating Patient-Generated Health Data From Smartwatches With Electronic Health Records: Usability Study.

BackgroundWearable technology, such as smartwatches, can capture valuable patient-generated data and help inform patient care. Electronic health records provide logical and practical platforms for including such data, but it is necessary to evaluate the way the data are presented and visualized.ObjectiveThe aim of this study is to evaluate a graphical interface that displays patients’ health data from smartwatches, mimicking the integration within the environment of electronic health records.MethodsA total of 12 health care professionals evaluated a simulated interface using a usability scale questionnaire, testing the clarity of the interface, colors, usefulness of information, navigation, and readability of text.ResultsThe interface was positively received, with 14 out of the 16 questions generating a score of 5 or greater among at least 75% of participants (9/12). On an 8-point Likert scale, the highest rated features of the interface were quick turnaround times (mean score 7.1), readability of the text (mean score 6.8), and use of terminology/abbreviations (mean score 6.75).ConclusionsCollaborating with health care professionals to develop and refine a graphical interface for visualizing patients’ health data from smartwatches revealed that the key elements of the interface were acceptable. The implementation of such data from smartwatches and other mobile devices within electronic health records should consider the opinions of key stakeholders as the development of this platform progresses.

Scenarios for the future of tourism in Iran (case study: Hormozgan province)

ABSTRACT The identification of future trends and the anticipation of market changes have become determinant to the competitiveness of organizations. Scenario planning is a useful tool in dealing with change and uncertainty. The present study aims at developing a tourism scenario, based on heuristic logic approach and the opinions of key stakeholders and actors for Hormozgan province in southern Iran. This study tried to recognize the main factors affecting the tourism industry in Hormozgan province by interviewing experts and determining the significance and uncertainty of the factors as well as key factors influencing the future of tourism using the matrix of influence and dependency to illustrate four possible scenarios for tourism in Hormozgan province in the 10-year horizon, these scenarios can be useful and efficient for managers, decision makers, and stakeholders in tourism.

Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania

BackgroundMalaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on the national progress towards malaria elimination, the potential of currently available vector control interventions in helping achieve elimination by 2030, and the need for alternative interventions that could be used to supplement malaria elimination efforts in Tanzania.MethodsIn this exploratory qualitative study, Focus group discussions were held with policy-makers, regulators, research scientists and community members. Malaria control interventions discussed were: (a) improved housing, (b) larval source management, (c) mass drug administration (MDA) with ivermectin to reduce vector densities, (d) release of modified mosquitoes, including genetically modified or irradiated mosquitoes, (e) targeted spraying of mosquito swarms, and (f) spatial repellents.ResultsLarval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was the least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members, who instead expressed strong support for programmes to improve housing for poor people in high transmission areas. Policy makers, however, challenged the idea of government-supported housing improvement due to its perceived high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered a high degree of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision-making.ConclusionStakeholder opinions regarding alternative malaria interventions were divergent except for larval source management and spatial repellents, for which there was universal support. MDA with ivermectin, housing improvement and modified mosquitoes were also widely supported, though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their reliance on scientists to make informed decisions, their reasoning on the benefits and disadvantages of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between research scientists, policy makers, regulators and communities regarding new interventions.

Clinical trial recommendations for potential Alport syndrome therapies

Alport syndrome is experiencing a remarkable increase in preclinical investigations. To proactively address the needs of the Alport syndrome community, as well as offer clarity for future clinical research sponsors, the Alport Syndrome Foundation hosted a workshop to generate consensus recommendations for prospective trials for conventional drugs. Opinions of key stakeholders were carefully considered, including those of the biopharmaceutical industry representatives, academic researchers, clinicians, regulatory agency representatives, and-most critically-patients with Alport syndrome. Recommendations were established for preclinical researchers, the use and selection of biomarkers, standards of care, clinical trial designs, trial eligibility criteria and outcomes, pediatric trial considerations, and considerations for patient engagement, recruitment, and treatment. This paper outlines their recommendations.

Privačių ikimokyklinio ugdymo įstaigų vadovų kompetencijų svarba: suinteresuotųjų šalių analizė

Privačių ikimokyklinio ugdymo įstaigų vadyba dar menkai tyrinėta, todėl nėra žinoma, kokių kompetencijų vadovas būtų tinkamiausias tokio tipo įstaigoms, kokio vadovo pageidautų svarbiausios suinteresuotosios šalys, kaip jos vertina vadovui reikalingas kompetencijas.Empiriniu tyrimu palyginamas svarbiausių privačių ikimokyklinio ugdymo įstaigų suinteresuotųjų šalių – steigėjų, vadovų, darbuotojų ir tėvų (tiek esamų, tiek potencialių klientų) – požiūris į teorinį vadovo kompetencijų modelį.Apibendrintas modelio rangavimas rodo, kad svarbiausia vadovo kompetencijų grupe yra laikytinas, visų pirma, vadovo gebėjimas kurti pasitikėjimą.

Проблемы развития аспирантуры в федеральных университетах: анализ мнений ключевых стейкхолдеров

Проблемы развития аспирантуры в федеральных университетах: анализ мнений ключевых стейкхолдеров

OP138 Stakeholders’ Involvement When Developing A mHealth Assessment Tool

IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technologies there is a need to have assessment tools based on their particularities to be used by health technology assessment (HTA) agencies and evaluation experts. In the development of a comprehensive and practical evaluation tool for the evaluation of mHealth solutions we aimed to include the views and opinions of key stakeholders: health professionals, developers, hospital managers, HTA agencies, patients and general public.MethodsFocus groups and an online modification of the Delphi technique are being used to discuss and agree on domains and criteria to be included in the mHealth assessment tool. Domains and criteria used for health apps evaluation were drawn from a literature review on the topic. The initial list includes 95 criteria grouped into the following domains: purpose of the app, privacy and security, clinical effectiveness, content of the intervention, user experience and usability, interoperability, expenses, impact on the organization, and legal and ethical aspects. Data coming from focus groups is currently being analyzed from a thematic and content analysis perspective.ResultsFocus groups with professionals have showed that the most important domains to be considered when evaluating health apps are those related with security, user experience, and clinical effectiveness. Some criteria were considered to be mandatory (mainly regarding safety issues), on which a first step assessment should indicate whether the app ‘pass or fails’ for the subsequent throughout assessment. Focus groups with patients will provide insight on critical aspects related to the choice, use and adherence to a health app.ConclusionsInsights from main stakeholders on the design of the tool for mHealth assessment are relevant and complementary between them. Next steps include (i) the agreement of criteria by using an online modification of the Delphi Technique and (ii) piloting of the tool.

Payment system of urban family physician programme in the Islamic Republic of Iran: is it appropriate?

The payment system is pivotal in implementing policies in the health sector. Equitable access to healthcare is the main principle of the payment system. This study aimed to investigate aspects of the payment system in the urban family physician programme (FPP) in the Islamic Republic of Iran. This was a qualitative study. We obtained data from key informants and both formal and grey literature. We used content analysis for data analysis. A range of concepts was explored related to the payment system of the FPP. By merging similar expressions, we categorized the findings into four main themes including: payment method, payment criteria and incentives, payment process and amount of payment. FPP is required to follow convenient implementation methods. The mechanisms of payment in the health sector are weak and have no transparency. A blurred combination of criteria makes an unclear process for determining the payment mechanisms. It is recommended that the opinions of key stakeholders be taken into consideration prior to developing payment mechanisms and financial incentives.

Clientele satisfaction towards the public-private partnership extension model introduced for technology dissemination in tea smallholding sector in Sri Lanka

This empirical study aims to explore the potentials of a public–private partnership (PPP) extension model by appraising the partners’ willingness for such an extension model for effective transfer of technologies as a remedy to fill the gap in the extension service to tea smallholders in Sri Lanka. By assessing its strengths and weaknesses using opinions of key stakeholders, the formulated model was applied to six extension channels (two factory based, two society-based and two agro-inputs dealer oriented extension channels)of the tea smallholding sector in the Matara and Ratnapura Districts. A survey was conducted using 180 randomly selected smallholders and primary data on their social status, extent cultivated, yield and other field data, inputs, source of information, degree of collaboration and type of extension activities were collected, Regular monitoring of extension activities of the participants in the selected channels was carried out for a period of 12 months. The satisfaction and perceptions of the services received from the specific extension channel was assessed by using scales. The primary and secondary evaluation data at different stages of implementation were statistically analysed using SPSS package. The results confirm the smallholder satisfaction on effectiveness of collaborative approach PPP model in all dimensions (Frequency, Adequacy, Usefulness, Relevancy and overall satisfaction). The level of perception on partnership significantly correlated with their exposure to extension activities (p < 0.001) and their commitment (p<0.05) towards extension programs. The PPP extension model implemented in this study is proven as effective in all dimensions (p < 0.05). Hence, it is recommended that the organizations responsible develop management and fiscal procedures to adopt this model to better serve the smallholders.

Stakeholders\u2019 views on the strengths and weaknesses of maternal care financing and its reform in Georgia

BackgroundThe improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects.MethodsA qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7–8 women. Two focus group discussions were carried out at each of the target settings (i.e. Tbilisi, Imereti and Adjara). Women were selected in each location through the hospital registry and snowballing method.ResultsThe evidence shows that there is a consensus among maternal care stakeholder groups on the influence of the healthcare financing reforms on maternal health. Specifically, the privatization of the maternal care services has had positive effects because it significantly improved the environment and technical capacity of the maternity houses. Also, in contrast to other former-soviet republics, there are no informal payments anymore for maternal care in Georgia. However the privatization, which was done without strict regulation, negatively influenced the reform process and provided the possibility to private providers to manipulate the formal user fees in maternal care. Stakeholders also indicated that the UHC programs implemented at the last stage of the healthcare financing reform as well as other state maternal health programs protect women from catastrophic health care expenditure.ConclusionThe results suggest a consensus among stakeholders on the influence of the healthcare financing reform on maternal healthcare. The total privatization of the maternal care services has had positive effects because it significantly improved the environment and the technical capacity of the maternity house. However, the aim to improve maternal health and to reduce maternal mortality was not fully achieved. Financial protection of mothers should be further studied to identify vulnerable groups who should be targeted in future programs.