Theory Of Participation Research Articles

Impact of the Community Radio on Local Development in Chapai Nawabganj, Bangladesh

Community radio serves as a platform for rural, marginalized, and hard-to-reach populations to express and exchange views, ideas, and concerns with the wider community. Its increasing popularity in recent years has provided both policymakers and grassroots individuals with an avenue to engage in the development process of their communities. In Bangladesh, community radio stations now broadcast 170 hours of daily programs, with the majority aimed at addressing local development goals in rural areas. These programs motivate people, bridge gaps, and collaborate on agendas such as poverty reduction, reducing inequalities, promoting education, good health, clean water, and sanitation. Additionally, community radio has provided a platform for the poor and marginalized communities to raise their voices and become the voice for the voiceless. This study, conducted using participatory theory, aims to underscore the significance and impact of community radio on the development of marginalized community at Chapai Nawabganj, Rajshahi, Bangladesh. The findings indicate that community radio plays a crucial role in local development, providing essential information and bridging the gap between ordinary people and local government in rural areas. The current research was carried out in Chapai Nawabganj, Rajshahi, Bangladesh, with the support of the local community radio station, Radio Mahananda 98.8 FM. The study found that involvement in and awareness of Radio Mahananda programs significantly influenced local development.

STATE POLICY AS A FORM OF TARGETED STATE ACTIVITY

The article examines state policy as an organized and purposeful activity of the state, which provides for the protection of public interests, ensures the adoption of balanced and justified state decisions, and contributes to the stable development of Ukrainian society. Issues of state policy formation in the system of planning and implementation of development plans of modern society are considered. It was determined that with the transition from bureaucratic forms to innovative methods of managing the state and society, state policy acquires certain signs of publicity, due to the involvement of both state and non-state public organizations in its implementation. It has been proven that the European integration of Ukraine is accompanied by changes in state policy, which is based on European values ​​and standards for the formation of a legal, social and democratic state. Therefore, it is better to use the term «public policy», as active purposeful actions of the state based on the cooperation of state institutions, civil society institutions, as well as non-state organizations and individual citizens. It is noted that the participatory theory of democracy should become a universal principle of organizing the public policy of the Ukrainian state. Because the basis of the effective functioning of participatory democracy is a developed civil society, as well as public trust in the activities of state and public institutions, that is, citizens' confidence in the correctness of the actions of public authorities to implement the goals announced by the state. It is substantiated that modern state (public) policy, firstly, is designed to ensure public expression of will, expression of interests and needs of the population and their practical implementation at the level of power institutions; secondly, it should be based on the principles of: openness, transparency and democracy; thirdly, in the process of development and implementation of political decisions, civil society institutions should be involved in this work. The specific characteristics of state policy as an active activity are singled out, which distinguish it from a whole array of other types of policies. In further studies, it is suggested to pay attention to the normative and legal regulation of state policy.

Political Participation for Social Inclusion of Internally Displaced Persons

Internally displaced persons (IDPs) have suffered multiple disadvantages and experienced social exclusion due to involuntary movement to new communities where they struggle to find opportunities for social inclusion. This study examined the political dimensions of social inclusion which focus on engaging IDPs in decision-making on issues that concern them. The study used the democratic participatory theory as a framework for political participation through decision-making. The qualitative exploratory study used in-depth interviews to collect data from twelve IDPs, comprising five females and seven males, who were resident in Benue State, Nigeria. Findings show that government does not incorporate the decisions and choices of IDPs when designing humanitarian measures for protection and assistance; IDPs are not communicated with on issues of interest to them; and IPDs lack sustainable opportunities for interaction with host communities. The study concludes that not incorporating the decisions of IDPs in issues of interest to them creates a culture of humanitarian aid dependency. The study recommends democratising solutions by using grassroots bottom-up measures for sustainable social inclusion of IDPs where solutions emerge from IDPs who are the end beneficiaries of the interventions. A discussion of the study findings is followed by concluding recommendations.

From conflict to collaboration through inclusive landscape governance: Evidence from a contested landscape in Ghana

The Western Wildlife Corridor (WWC) in Ghana’s Northern Savannah ecological zone is a contested landscape where efforts to reverse widespread environmental degradation often conflict with local livelihood concerns and broader development objectives. Despite policy measures to devolve natural resource decision-making authority, poor environmental management, persistent socioeconomic challenges, and increasingly limited livelihood opportunities for people living within the corridor prevail. This study investigates environmental degradation in the WWC and natural resource governance using information on stakeholder perceptions from stakeholder workshops, focus group discussions, and key informant interviews. We also explore how natural resource management might be strengthened to better deliver social, economic, and environmental goals. We found that despite a history of contestation, stakeholders were able to agree upon specific issues of common concern and generate a collaborative vision for the WWC landscape. Transitioning toward such a vision requires significant investment in strengthening current governance structures and building natural resource management capacity within the corridor and beyond. Furthermore, persistent challenges of conflicting stakeholder objectives and issues related to coordination, corruption, and non-inclusion in decision-making about natural resources must be addressed to advance progress. Stakeholders were able to formulate specific recommendations and a participatory theory of change to inform the development of a sustainable landscape management plan and future evidence-based policy that could steer the WWC toward a more resilient and multifunctional system that equitably supports livelihoods, biodiversity, and wider economic development. The methods for inclusive engagement in environmental decision-making are extrapolatable to other contexts facing similar social-environmental challenges.

Bringing stakeholders on board in the development of integrated care through the Theory of Change approach

Similar to other fields, research and implementation in the field of long-term care (LTC) provision in the community increasingly focuses on taking on participative approaches to improve the quality of LTC. However, levels of participation differ vastly in terms of needed resources, aims and opportunities - ranging from informing experts by experience to co-design and involvement in action research. Our presentation is targeted at providers, policy makers and researchers who aim for engaging diverse stakeholders in the development of LTC in the community. We will present how InCARE included a wide range of stakeholders, including experts by experience, in developing three pilot projects aiming at improving LTC for older people in Spain, North Macedonia and Austria. We will focus on how we used the Theory of Change (ToC) approach and subsequent stakeholder workshops in the Austrian pilot project context. This participation process started in 2021 and aimed at informing and engaging stakeholders in the field of LTC in the province of Styria. Two consecutive participatory Theory of Change workshops prior to the project implementation phase both contributed to the quality of the pilot project by adapting it to the local context, and also heightened interest locally and regionally. Subsequent stakeholder workshops tackled issues raised in the ToC workshops, such as financing of LTC provision and relief options for informal carers. Starting the project during a time of thorough Covid-19 restrictions, the ToC workshops had to be conducted online. For various reasons, we decided to use online formats also for subsequent stakeholder workshops in the year 2022. We will present the advantages and challenges of using Theory of Change for stakeholder engagement, including the structuring of the process, the adaptation to the local context, how to heighten a sense of ownership, and what resources are needed. We will also highlight the advantages and disadvantages of online formats, including possibilities for a less-hierarchical communication. Taking the implementation of the local pilot project as an example, we will also link our experience to questions of participation, representation by proxy, self-representation and political representation. 

Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia

ABSTRACT Objective To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. Method We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used “ADAPT” guidance to adapt the intervention to the context, before mapping potential harms in a “dark logic model”. Results Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. Conclusion Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.

Stakeholder’ Engagement and Sustainability of Donor-Funded Rehabilitation Centers in Kiambu County, Kenya

Allowing stakeholders to set the vision of a project and prioritizing results will enable them to possess the appropriate ideas throughout planning with the results remaining relevant to them during the project cycle. The aim of the study was to assess the effect of stakeholders’ engagement on the sustainability of donor-funded rehabilitation centers in Kiambu County, Kenya. The study was anchored on Stakeholder and Arnstein’s Participatory Theories. Descriptive research design was adopted and the targeted population was composed of 400 employees working in donor-funded rehabilitation centers in Kiambu County. The researcher used a stratified random sampling technique and a sample of 200 individuals participated in the study. Data was collected using a questionnaire and the results analyzed using descriptive and inferential statistics, with the aid of the Statistical Package for Social Sciences. Linear regression analysis was adopted and the outcome showed that donor-funded projects succeed when functional stakeholders are included. Additionally, a project's long-term viability is influenced by the resources that underpin it, and by the amount of interest and involvement from its stakeholders. The study recommends that the National and County Governments in Kiambu County should establish laws that control the execution of sustainability for donor-funded projects and invest in stakeholders to guarantee accountable use of funds. During the period of implementation, those in charge of projects should make it a priority to ensure that all relevant stakeholders have access to the resources they need to engage fully in the initiatives. There has to be a mental shift on the part of those who stand to benefit from the donor initiatives as well as the society as a whole. In order to adhere to study ethics, the researcher requested approval from Kenyatta University, National Commission for Science, Technology and Innovation and the management of the rehabilitation centers in Kiambu County. Additionally, the data gathered will only be used for academic reasons, anonymity and confidentiality adhered to and the references and works used in the paper are acknowledged. Keywords: Stakeholders, Donors, Donor-Funded, Sustainability, Rehabilitation Centers

Community Participation in National Addresses and Postcode System Establishment in Tanzania

Abstract This study seeks to understand whether the Tanzanian community participated in the establishment of national addresses and postcode systems following the need of the government of Tanzania to establish residential addresses and postcodes through the guidance of the electronic and postal communications act of 2003 for the purpose of identifying streets by indicating specific names and business centers as well as naming the number of houses. Through the participatory theory approach and communication theory, this article analyses the contents which describe the involvement of Tanzanians in establishing the national address and postcode systems. Through in-depth interviews, the study findings indicate that community participation in selecting and establishing names for the streets and post code systems was relatively low. This was characterized by low awareness of the community concerning; less communication within the community through which the project was taking place; within the society; and poor involvement of people within the society. This finding concludes that community participation in any project has the potential for both social and economic development activities within and outside of society.

Using participatory action research to reimagine community mental health services in Colombia: a mixed-method study protocol

IntroductionMental healthcare systems are challenged by how they hear and respond to what marginalised communities experience as drivers of mental distress. In Colombia, this challenge intersects with wider challenges facing...

Intelligence community and private guard companies in Nigeria: The missing national security architecture links

The yawning loop between federal security agencies and the private security industries has an aggravating effects on the nonresponsiveness of the national security architecture, where almost all actors are siloed in a stand-alone-mode. As an interactive national security architecture fusing federal security agencies with private Guard Companies in Intelligence sharing networks, as seen in developed clime could have a catalytic effects on national security architecture. It was against this backdrop that this study leverages on participatory theory (Network Analysis Theory) to investigate the impact of intelligence community and private guard companies on national security architecture in Nigeria. The study deconstruct National Security into, economic security and education security. This study adopts qualitative research design using exploratory research design on publicly available archive documents; study also relies solely on secondary data. The research is conducted by examining literature concerning private security industry, national security architecture, intelligence community and its effects on human security in Nigeria. The literature was obtained through searches in publicly available material. Literature from non-serial publications, official reports, and conferences has been included particularly if they have been cited by other references in term of intelligence sharing and private Guard companies and effects on national security architecture. Results that originate from this study revealed that one of the effects of intelligence sharing between private security industry and government security agencies correlates with economic security in job provisions and upyick startup tech industry. Result also submits that intelligence sharing of players domicile in the security architecture alongside private security industry positively influences public safety which could reinforces the Global safe school projects and slow down the widening illiteracy trajectories. The study recommends that government should establish fusion centres for all actors particularly, private security industry and NSCDC, as it will consolidate nation’s economic security further. Study also recommends that while private security could assist in the Safe school projects, NSCDC should provide the needed horizon security which ensures public safety.

Local Government Caretaker Committees in Nigeria and their Effects on Socio-Economic Development

The state governors in Nigeria have manipulated the local government councils in Nigeria to the extent that they appoint their cronies and loyalists as caretaker committee chairmen without regard to the constitutional provisions for democratically elected council chairmen. In all cases, the choice of their appointees is not always the choice and wishes of the local people and the masses at the grassroot always rejected them. The most fundamental problem inherent in caretaker committees of local government council is that caretaker committees are conduit pipes for corruption by the state governors to siphon off local government councils’ finances. The state governors solely or in tandem with their party leaders handpick few individuals viewed as core loyalists to the governors. Local government councils ought to be managed by democratically elected individuals and not the state governors appointing their cronies and loyalists as caretaker committees’ chairmen without regard to the constitutional provisions for democratically elected local government council’s chairmen. Presently in Nigeria, the state governors are truncating the tenure of the democratically elected council officials and replacing them with members of the ruling political party in the state as caretaker committee. We perused at the constitutional provisions for local government councils through the Democratic Participatory Theory. This paper studied carefully the reasons for state governors in Nigeria setting up caretaker committees and the impact of these committees on local government councils in the country. Based on the conducts of the state governors, it was recommended that state governors who fail, neglect and refuse to conduct free and fair elections for local government councils in a state should be prosecuted after their tenures and if found guilty be given maximum capital punishment. This would serve as a deterrent to others in the future, among others.

Megacity crime management strategies on human security: Evidence of target hardening and developmental prevention in Lagos state, Nigeria

Lagos, a port and land border megacity, is assailed by waves of violent crimes, alarming traffic blight, unresponsive Federal system of government as been under policed in the face of leap bounding population. How the State has found her own security expression voice independent of the newly created regional Amotekun Security Network is attracting academic attention. It was against this background that this study engaged participatory Theory to analyse megacity crime management strategies on human security in Lagos state, Nigeria. The study employs target hardening and developmental prevention security approaches to measure crime management strategies as it relates to human security. This study adopts qualitative research design using content analysis of publicly available archived documents with reliance on secondary data. The research is conducted by reviewing literature pertaining to crime management strategies, violent crime and its effects on human security in a megacity setting. The literature was obtained through searches in publicly available material. Literature from non-serial publications, official reports, and conferences has been included particularly if they have been cited by other references in term crime management strategies. Results that emanate from this study revealed target hardening positively correlate with provision of human security, while result also shows a disconnect between the State’s developmental prevention strategy and human security. This study also submits that prevalence of violent crimes in Lagos state is as fallout of poor crime management strategies. The study recommends that Lagos state government should invest more into target hardening towards achieving a safer city while the Federal Government should also give a support as a safer Lagos translates to confidence of foreign investors in the country. The study also recommends that Lagos state government should engage more NGOs in evolving a stronger developmental protection strategy, deeply inculcated in both formal and informal educational system in order to stems traces of crime and criminalities at tender ages.

Survey on Residents' Willingness to Participate in Sponge Transformation and Construction of Old Residential Areas in Anhui Province

The sponge transformation of old residential areas is one of the keys to the popularization of sponge city construction. The investigation of residents' willingness to participate in the sponge transformation of old residential areas in Anhui Province can not only promote the sponge city construction in Anhui Province, but also provide a reference for the sponge city construction in the whole country and improve the construction efficiency. Based on the participatory theory, the residents in the old residential areas were selected as the research objects, and the residents' willingness to participate in sponge city reconstruction was investigated through questionnaires, and the sponge city reconstruction policy was popularized. To explore the willingness of residents to participate in the sponge city reconstruction of old residential areas, so as to provide ideas and countermeasures for the construction of new urbanization and accelerate the progress of new urbanization.

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

BackgroundEvidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia.MethodsWe employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff.ResultsIn the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0).ConclusionUsing a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.

The Nigerian State and Democratic Governance: A Need for Revisitation of Democratic Ethos

The study examined the practice of democracy in Nigeria, bearing in mind the tenets of democracy. Democracy has been accepted as the most viable and sustainable form of government by world leaders and is used to determine the extent of freedom enjoyed in different countries of the world. However, the availability of the freedom it offers in Nigeria is questionable. This is largely due to the lack of democratic principles such as free, fair and credible elections, mass participation in the governance processes, independence of the judiciary, rule of law, etc. While successive governments since 1999 have verbalized efforts at strengthening democratic ethos/culture in the country, observers are of the view that the democratic practice in Nigeria is a far cry from the acceptable norms. Therefore, the main objective of this study is to examine the extent to which democratic ethos have been institutionalized in the Nigerian State. The study adopted the Participatory Theory of democracy, its main idea being the provision of greater involvement and control over all governmental laws and non-governmental rules pertaining to the citizens, and to analyze the imperative to revisit the practice of democracy in Nigeria. The study relied mainly on secondary data focusing on the nature and character of democratic governance in the country. The study revealed that efforts at institutionalizing democracy, enhancing mass participation as well as achieving development had not yielded the desired outcomes in the country. This is evident in the increasing rate of electoral violence that characterizes elections over the years in the country. The paper concluded that, for Nigeria to substantially deliver the “dividends of democracy” to the people, the state must revisit the culture and practice of democracy in the country. The study recommended, among other things, that the state should strive to uphold the rule of law at all times, ensure judicial independence, enhance mass participation in the governance processes and efforts should also be made to guarantee free, fair and credible elections.

Successful Implementation of Peer Support for People with Severe Mental Illness in Germany: a Theory of Change Approach

Peer support is an established intervention in which people with mental illness receive support by trained peer support workers who have already overcome a mental health crisis. The implementation of peer support is complex due to interacting factors and can be achieved through the participatory Theory of Change method. Aim of this study is to develop a cross-site Theory of Change for the sustainable implementation of UPSIDES peer support in Germany. Based on site-specific Theories of Change workshops from Ulm and Hamburg in which 47 participants took part, a cross-site Theory of Change was designed and verified in three follow-up workshops with 12 participants. Participants' professional and experiential backgrounds were diverse, including peer support workers, hospital directors and managers, mental health professionals (psychiatrists, psychotherapists, nurses), and researchers. The first pathway of the cross-site Theory of Change focuses on the training of peer support workers, whereas the second pathway emphasizes recognition and integration by mental health institutions and professionals. The third pathway specifies the building of a cross-professional care network to integrate various peer support services. Procedures to approach prospective peer clients are depicted in the fourth pathway. The fifth path addresses the clarification of the role description of peer support workers and the implementation in other institutions through cooperation. Many of the identified implementation steps have been validated in comparable studies. The development of this Theory of Change by bringing together multiple perspectives of key stakeholders is an important basis for the sustainable implementation of UPSIDES peer support. Furthermore, it may serve as a blueprint for the implementation of similar interventions to advance scaling-up of evidence-based user-led and recovery-oriented interventions. The Theory of Change approach is a well-accepted and feasible method, which can be recommended for the implementation of complex interventions such as UPSIDES peer support.

A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial

BackgroundStaff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff’s sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers’ basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level.MethodsWe developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study.DiscussionThis study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022.Trial registrationNetherlands Trial Register, NL9627. Registered 29 July 2021 - Retrospectively registered.

Teoría del cambio aplicada al programa de promoción de la actividad física «La Ribera Camina»

ObjectiveTo develop a theory of change of a program to promote physical activity in eleven health districts, in order to improve its design and plan its evaluation. MethodFour focus groups were carried out, to develop a participatory theory of change, to identify the expected changes (long, medium and short term) of “La Ribera Camina” program, according to the following stakeholders: primary healthcare professionals, local government representatives and community members. A thematic analysis was used to identify the actions to be taken to achieve these changes, as well as the difficulties and facilitators to enhance the sustainability of the program. ResultsThe identified changes were classified into four themes: 1) changes in physical and social health (improved physical condition, healthy habits, self-esteem and perceived well-being); 2) organizational and relational changes (better coordination between institutions); 3) specific changes to the program (incorporation of more “assets” and local associations, especially male participants, more trails and schedules); and 4) changes in the environment (improved trails’ infrastructures and safety). ConclusionsThe theory of change allows to identify and classify the changes that are expected, the actions to be carried out and the links between elements of the program. This will serve as the basis for its evaluation. This methodology could be applied to other programs interested in incorporating intersectorality and community engagement in their design and evaluation.

Beyond Parliament: Gandhian Democracy and Postcolonial Founding

Through a study of Gandhian political writings in mid-twentieth-century India, this article explores the neglected question of how the issue of representative democracy shaped anticolonial thought. The rise of a Gandhian perspective on electoral representation was made possible by the account of modern democracy given in Gandhi’s "Hind Swaraj" (1909). From the 1930s, four key Indian thinkers influenced by Gandhi expanded on "Hind Swaraj" to argue that capitalist economics were a threat to democratic equality and produced the kinds of unaccountability and elite capture of legislatures that they identified in Western European parliamentary states. In response, Gandhian thinkers developed proposals for federalist postcolonial constitutions, combining a system of participatory legislative councils with collectivist agrarian socialism. I trace the intellectual origins of Gandhian democratic thought in the 1930s and 1940s and outline how its main proponents articulated ideas of antiparliamentarism and moral economics. Revisiting the Gandhian tradition, I suggest, highlights the importance of economic ethics in participatory theories of democracy and popular sovereignty.

Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study

BackgroundDuring the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low-resource settings, and are associated with domestic violence, poverty, and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town.MethodsThis study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral, and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback, and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with the delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes.DiscussionThis pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing HSS interventions for perinatal women with depression, anxiety, or experiences of domestic violence in low-resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought.