Pilot District Research Articles

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BackgroundWhile mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.MethodsData was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.ResultsFrom 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of − 3.50 (95% CI -6.28 ~ − 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.ConclusionsThe implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa


 
 
 Background. The first phase of the National Health Insurance (NHI) pilot programme focusing on primary healthcare has been implemented in Tshwane and 10 other districts of South Africa since 2012. This was envisaged to improve the quality of healthcare at primary healthcare level, and offset the burden of non-emergency healthcare at hospital outpatient level. However, there are no population-level studies that have been done to determine the relationship and interdependence of primary healthcare and hospital outpatient-level indicators that are needed to forecast utilisation of health services. This information is key to plan for roll-out of NHI, in setting benchmarks to guide health policy and allocation of resources.
 Objectives. To determine the interdependence and relationships between primary healthcare and hospital outpatient-level indicators in a NHI pilot district, and forecast the utilisation of services to 2030.Methods. This was a quasi-experimental ecological study design, making use of selected primary healthcare and outpatient department indicators in the District Health Information System monthly reports between January 2010 and December 2019 for Tshwane district. We used the vector error correction model to determine the interdependence and relationships between these indicators, and used these to forecast utilisation of services to 2030.
 Results. The study found that most non-emergency care is provided at primary healthcare level by professional nurses. It confirmed the influence of selected primary healthcare and outpatient department headcounts on each other by finding the existence of four co-integration relationships between the variables. Both long-run and short-run causality exists between them. Based on these relationships, we forecasted that by the end of 2030, the outpatient department follow-up headcounts would have doubled, but both primary healthcare total and clients seen by a professional nurse will marginally decline.
 Conclusion. Our findings confirm that there is a relationship between primary healthcare and outpatient department indicators, which can be used to plan for provision of services in the future. Based on this relationship and current trends, we found that implementation of the NHI pilot programme will not attain the envisaged goal by 2030.
 
 

Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa

Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa

Rainfall and Earthquake-induced Landslide Susceptibility Assessment

When rainfall and earthquake occur simultaneously, large-scale landslides can cause direct damage to lives and structures. To reduce such large-scale landslide damage, rainfall and earthquake-induced landslide susceptibility has to be evaluated. Therefore, in this study, landslide susceptibility was evaluated by considering only rainfall, only earthquake, and both rainfall and earthquake in the Atsuma region of Japan, where a large-scale landslide was triggered by a combination of rainfall and earthquake. Through quantitative index analysis, the accuracy of the landslide susceptibility map was improved when both rainfall and earthquake were considered. The proposed method was also applied to the Naari basin in Yangnam-myeon, Gyeongju as a pilot district. We found that the landslide-susceptible area increased when rainfall and earthquake were considered simultaneously than when rainfall and earthquake were considered separately. Through such research, can be used as basic data for complex disaster vulnerability assessment.

Open Urban Space Regeneration Strategies Based on Urban Welfare: A Project and Experiment in the San Lorenzo District in Rome, Italy

The current socio-economic dynamics and the consequences induced by the pandemic emergency have generated a reflection on the need to recover the dimension of proximity and to share resources, spaces, infrastructures, and experiences. This solicits a remodelling of the system of public open spaces, based on a resilient, adaptive model; multifunctional and linked to the temporality of the functions that spaces can accommodate. The paper deals with the issues of planning and design of public open spaces around the needs of proximity and welfare. This is achieved through collecting and systematizing state of the art concepts on the role of public space within the urban structure of the city, and the formulation of guidelines for design, deduced from an empirical application conducted on a pilot district in the city of Rome. The paper aims to suggest to policymakers and planners a new approach and a path for future research and practice in the planning and design of more sustainable and inclusive green areas and public spaces, meeting the diverse needs of citizens. We undertook this objective through the experimental application of an intervention methodology on the public space system of the San Lorenzo neighbourhood in Rome.

Testing the contextual Interaction theory in a UHC pilot district in South Africa

BackgroundWorld-wide, there is growing universal health coverage (UHC) enthusiasm. The South African government began piloting policies aimed at achieving UHC in 2012. These UHC policies have been and are being rolled out in the ten selected pilot districts. Our study explored policy implementation experiences of 71 actors involved in UHC policy implementation, in one South African pilot district using the Contextual Interaction Theory (CIT) lens.MethodOur study applied a two-actor deductive theory of implementation, Contextual Interaction Theory (CIT) to analyse 71 key informant interviews from one National Health Insurance (NHI) pilot district in South Africa. The theory uses motivation, information, power, resources and the interaction of these to explain implementation experiences and outcomes. The research question centred on the utility of CIT tenets in explaining the observed implementation experiences of actors and outcomes particularly policy- practice gaps.ResultsAll CIT central tenets (information, motivation, power, resources and interactions) were alluded to by actors in their policy implementation experiences, a lack or presence of these tenets were explained as either a facilitator or barrier to policy implementation. This theory was found as very useful in explaining policy implementation experiences of both policy makers and facilitators.ConclusionA central tenet that was present in this context but not fully captured by CIT was leadership. Leadership interactions were revealed as critical for policy implementation, hence we propose the inclusion of leadership interactions to the current CIT central tenets, to become motivation, information, power, resources, leadership and interactions of all these.

Scaling up DAKSH intrapartum application: impact, challenges, and learning

Background: DAKSH is an intrapartum monitoring application. It is easy to use, saves time and requires no interpretation skills. In spite of all these advantages, using a digital partograph alone will lead to less benefits to healthcare workers. So an application was developed which includes workflows for registering the patients during the intrapartum period by entering their investigation details, updating delivery/referral status and postpartum data until hospital discharge. The partograph is a major component of DAKSH. The main aim of this pilot was to simplify the use of partograph for better labour monitoring, which will help them in making early decisions for taking action for referral or intervention.Methods: This was a cross-sectional study. Permission to conduct a pilot for one block for 1 year was given by the Karnataka government (2017-18). After the results from the pilot district model were tested out in one district of Karnataka (2019). The pilot phase includes the following components: pre-implementation phase, implementation phase, monitoring and evaluation, regular monitoring through the dashboard and monthly evaluation visit to each health centre. The pre-implementation process was the same for both the block and district levels.Results: The few learnings learnt during the scaling up includes: the dual burden of work is considered as the main cause of not filling the partograph by staff nurses in DAKSH. Behavioural change was seen during the continuous visits while providing them with secondary training and motivation to use the application. The new kiosk provided with an inbuilt printer increased the printing of case sheets and partographs.Conclusions: This study concluded that the DAKSH application was developed for labour monitoring in healthcare facilities. The application was developed after proper need validation and feedback from OBGYNs. Further modifications and changes were made in the application from various valid user feedbacks and issues faced during the pilot which improved the user experience and sustainability.

Perceived quality of primary healthcare post-National Health Insurance pilot implementation

BackgroundContracting private medical practitioners for the National Health Insurance pilot project in 2012 by the National Department of Health in South Africa was envisaged to reduce workload at referral district hospitals by reducing self-referral by clients as the perceived quality of care at the primary healthcare level improves.AimTo describe the effect of contracting private medical practitioners at primary healthcare facilities on the self-referral rate of clients at district hospitals as a proxy for perceived quality of care in a National Health Insurance pilot district.SettingThe study was set in Tshwane National Health Insurance pilot district compared to Ekurhuleni district.MethodsWe compared findings before and after implementing the National Health Insurance private medical practitioners contracting between a pilot and a non-pilot district. A quasi-experimental ecological study design was used to compare district hospital outpatient department indicators of clients follow-up, self-referral, self-referral rate and referred in the two districts from June 2012 to May 2014 using single and controlled interrupted time-series analyses.ResultsControlled interrupted time series analysis found decreases in self-referral rate (−1.8 [−2.2, −1.1] [p < 0.0001]) and the initial trend of headcounts of self-referral (−516 [−969, −66] [p = 0.0260]), but an increase in headcounts of referred clients (1293 [77, 2508] [p = 0.0376]) in the pilot compared with the non-pilot district.ConclusionWe concluded that the implementation of contracting private medical practitioners in primary healthcare facilities might have resulted in an improved perceived quality of care at primary health care facilities. However, the higher number of outpatient department headcounts for follow-up and the increase in referred cases in the pilot district would need to be investigated.

Optimal Water Management in Agro-Industrial Districts: An Energy Hub’s Case Study in the Southeast of Spain

In this work, the optimal management of the water grid belonging to a pilot agro-industrial district, based on greenhouse cultivation, is analyzed. Different water supply plants are considered in the district, some of them using renewable energies as power sources, i.e., a solar thermal desalination plant and a nanofiltration facility powered up by a photovoltaic field. Moreover, the trade with the water public utility network is also taken into account. As demanding agents, a greenhouse and an office building are contemplated. Due to the different water necessities, demand profiles, and the heterogeneous nature of the different plants considered as supplier agents, the management of the whole plant is not trivial. In this way, an algorithm based on the energy hubs approach, which takes into account economic terms and the optimal use of the available resources in its formulation, is proposed for the pilot district with a cropping area of 616 m2. Simulation results are provided in order to evidence the benefits of the proposed technique in two cases: Case 1 considers the flexible operation of the desalination plant, whereas in Case 2 the working conditions are forced to equal the plant’s maximum capacity (Case 2). A flexible operation results in a weekly improvement of 4.68% in profit, an optimized use of the desalination plant, and a reduction of the consumption of water from the public grid by 58.1%.

Contracting of private medical practitioners in a National Health Insurance pilot district: What has been the effect on primary healthcare utilisation indicators?

BackgroundIn 2012, the National Department of Health in South Africa started contracting of private medical practitioners (MPs) as part of the first phase of National Health Insurance (NHI) in 11 pilot districts to improve access to healthcare.AimThe aim of this study was to describe the effect of contracting private MPs on the utilisation of primary healthcare (PHC) services in public healthcare facilities.SettingA National Health Insurance pilot district compared to a non-pilot district.MethodsA quasi-experimental ecological study design was used to compare selected PHC utilisation indicators in the District Health Management Information System from June 2010 to May 2014 between a pilot and a non-pilot district. Both single and controlled interrupted time series analyses were used for comparing before and after implementation of the intervention.FindingsSingle interrupted time series analysis showed an increase in adults remaining on anti-retroviral therapy, clients seen by a nurse practitioner and clients 5 years of age and older in both districts. However, controlled interrupted time series analysis found no difference in all parametres. Despite a decrease in total headcounts in both districts using single interrupted time series analysis, controlled interrupted time series analysis found no differences in all parameters before and after the intervention.ConclusionsThe increase in utilisation of PHC services in the pilot district may not be attributable to the implementation of contracting private MPs, but likely the result of other healthcare reforms and transitions taking place in both districts around the same time.

Analisis Deskriptif Produksi Jagung di Nusa Tenggara Timur

Corn is a commodity that plays a role in supporting food security other than rice and soybeans. Corn is not only used as raw material for the food and beverage industry, but also as animal feed ingredients. Factors affecting maize production in East Nusa Tenggara are fertilizers, pesticides, planting and cultivation patterns, formal education levels. The role of agricultural extension is very important because it is through them that renewable knowledge and technology can be distributed to local farmers. This is what can support East of Nusa Tenggara to become a corn center and become a province that contributes to Indonesia through self-sufficiency in corn food. South of Central Timor (TTS) can be used as a pilot district in increasing corn production.

Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

IntroductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.MethodsWe applied...

Spatial Aggregation Effect on Water Demand Peak Factor

A methodological framework for the estimation of the expected value of hourly peak water demand factor and its dependence on the spatial aggregation level is presented. The proposed methodology is based on the analysis of volumetric water meter measurements with a 1-h time aggregation, preferred by water companies for monitoring purposes. Using a peculiar sampling design, both a theoretical and an empirical estimation of the expected value of the peak factor and of the related standard error (confidence bands) are obtained as a function of the number of aggregated households (or equivalently of the number of users). The proposed methodology accounts for the cross-correlation among consumption time series describing local water demand behaviours. The effects of considering a finite population is also discussed. The framework is tested on a pilot District Metering Area with more than 1000 households equipped with a telemetry system with 1-h time aggregation. Results show that the peak factor can be expressed as a power function tending to an asymptotic value greater than one for the increasing number of aggregated households. The obtained peak values, compared with several literature studies, provide useful indications for the design and management of secondary branched pipes of water distribution systems.

Useful or Useless? Principal Perceptions of the Texas Principal Evaluation and Support System

Principal evaluations can be important tools for improving leadership practice, but evaluations have often described by principals and researchers as unsystematic and lacking timely and actionable feedback. This study examines principal perceptions of the Texas Principal Evaluation and Support System (T-PESS). Survey data and interviews of principals in one pilot district are used to answer two primary research questions: (a) How did veteran principals understand and experience the T-PESS? and (b) What aspects of the evaluation tool and process did principals find most useful and as barriers to their professional growth? Findings reveal that positive evaluator–principal relationships and goal-setting activities can support professional growth.

Varying universal health coverage policy implementation states: exploring the process and lessons learned from a national health insurance pilot site

Background Worldwide efforts have increased to understand what works in policy implementation, for whom and under what circumstances (context) are health policies useful and effective. All countries are striving towards Universal Health Coverage (UHC). Reforms are being implemented to ensure no-one is left behind. Methods We draw on our experiences of tracking implementation of policies aimed at achieving UHC in a national health insurance (NHI) pilot district (universal coverage in Tanzania and South Africa). Policies aimed at achieving UHC were tracked from 2011-2015 to understand why there are varying UHC policy implementation states and outcomes among facilities in the same district? Results Lessons learned in the process include: i) to adopt or adapt policy is a process – actors at the front-line seem to engage with policy, carry out a policy-context audit, try to engage with superiors if there are discrepancies between policy and context and eventually take a decision to adopt or adapt policy; ii) local facility contexts matter and vary – decision to implement policy is influenced by the conditions on the ground, hence implementation states can vary from one facility to the other despite being in the same district; iii) implementation states range from full policy adoption and implementation, policy adaptation and partial implementation, delayed implementation to non-implementation; iv) a resource audit before policy is implemented could go a long way in reducing policy-practice gaps; and v) Policy implementation states are dynamic subject to change – for example, when equipment breaks down and is not replaced immediately. Conclusion There seems to be inherent respect among implementing actors, for the department of health and people above them. They are however concerned with the fact that they are removed from the ground, could have lost touch with realities on the ground, hence the policy directives sent from the top, are often not congruent with ground conditions. Actors revealed how they engage with the policy, assess what they are being asked to do and compare that with the existing resources. To adopt or adapt policy in a UHC context: there seems to be a series of steps actors take.

Combining Machine Learning Analysis and Incentive-Based Genetic Algorithms to Optimise Energy District Renewable Self-Consumption in Demand-Response Programs

The recent rise of renewable energy sources connected to the distribution networks and the high peak consumptions requested by electric vehicle-charging bring new challenges for network operators. To operate smart electricity grids, cooperation between grid-owned and third-party assets becomes crucial. In this paper, we propose a methodology that combines machine learning with multi-objective optimization to accurately plan the exploitation of the energy district’s flexibility with the objective of reducing peak consumption and avoiding reverse power flow. Using historical data, acquired by the smart meters deployed on the pilot district, the district’s power profile can be predicted daily and analyzed to identify potentially critical issues on the network. District’s resources, such as electric vehicles, charging stations, photovoltaic panels, buildings energy management systems, and energy storage systems, have been modeled by taking into account their operational constraints and the multi-objective optimization has been adopted to identify the usage pattern that better suits the distribution operator’s (DSO) needs. The district is subject to incentives and penalties based on its ability to respond to the DSO request. Analysis of the results shows that this methodology can lead to a substantial reduction of both the reverse power flow and peak consumption.

Implementing an mhGAP-based training and supervision package to improve healthcare workers\u2019 competencies and access to mental health care in Malawi

BackgroundIt is now well established that the integration of mental health care into primary care is one of the most effective ways of reducing the substantial treatment gap for mental disorders which exists in most low- and middle-income countries. This study set out to determine whether a Mental Health Gap Action Programme (mhGAP) training and supervision package could be contextualised and implemented within the existing health care system in five districts in Southern Malawi. In addition, the study assessed the feasibility of holding community awareness events and establishing peer support groups in each district to further improve the access of the population to evidence-based mental health care.MethodsA lead training team of experienced Malawian mental health professionals was appointed and mhGAP training materials were contextualised for use in Malawi. The lead team delivered a 4-day training package to district mental health teams in five districts covering three core conditions: psychosis, moderate-severe depression, and alcohol and substance use disorders. District mental health teams then delivered a 2-day training package and provided monthly supervision for 3 months to 500 non-specialist healthcare workers. Paired sample t-tests were used to compare knowledge, confidence and attitude scores before and immediately after training, and after 6 months in two districts. Case detection rates measured pre- and post-training in the pilot district were compared using Wilcoxon Rank Sum Test. Community awareness events were held and peer support groups were established in each of the five districts. The acceptability of the package was assessed through focus group discussions involving specialist and non-specialist healthcare workers, users and carers.ResultsNon-specialist healthcare workers’ knowledge and confidence scores significantly increased immediately after training in comparison to pre-training. These scores were maintained at 6 months. However, no statistically significant change in attitude scores was detected. Case detection rates increased immediately after the training in comparison to pre-training. Responses from focus group discussion participants illustrated the programme’s acceptability.ConclusionsThis study demonstrated that, with minimal additional funding and working within existing structures, an mhGAP based training at primary and secondary health care levels is feasible in Southern Malawi.

Developing an Indicator System for a Healthy City: Taking an Urban Area as a Pilot.

PurposeThe Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China.MethodsData were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes.ResultsThe indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors.ConclusionThis indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.

Evaluation of a Crisis Intervention Team Pilot Program: Results from Baltimore, MD.

The Crisis Intervention Team (CIT) program was developed as a resource on which police officers could rely when responding to behavioral health calls for service. Baltimore Police Department (BPD) piloted the CIT program in its Central District to address concerns regarding officer attitudes toward and treatment of persons experiencing behavioral health crises. This study used mixed methods to evaluate the effect of the CIT pilot on BPD officer attitudes regarding persons with mental illness and confidence managing behavioral health calls for service. Officer surveys and small group analyses found that Central District officers were more confident handling behavioral health calls for service than Eastern District officers post-pilot. More officers in the pilot district felt better prepared for behavioral health calls for service post-pilot than officers in the control district. Results indicate the CIT program is effective at improving officer confidence and attitude towards responding to behavioral health calls for service.

IMPLEMENTATION OF THE ESTABLISHMENT A PILOT PROJECT FOR A CHILD-FRIENDLY SCHOOL IN KABUPATEN KAUR BENGKULU

Child Friendly Schools are schools / madrasas that are safe, clean, healthy, green, inclusive and comfortable for the physical, cognitive and psychosocial development of girls and boys including children who require special education and / or special service education; which openly involves children to participate in all activities, social life, and encourage children's growth and prosperity. The Child Friendly School Program launched by the government aims to improve the mainstreaming of children's rights in Indonesia. In the Province of Begkulu there is no Child Friendly School. Kaur Regency is currently a pilot district for the development of primary and secondary education in the province of Bengkulu. The determination of the pilot project for Child Friendly Schools is conducted by coordinating with the Education and Culture Office of Kaur Regency. For elementary school level, SDN 41 Kaur was chosen, given the school's reputation, strategic location and their readiness to implement this program. For the junior high school level, there were selected 36 PKLK junior high schools (Special Education Special Services). This school is boarding and for 24 hours students are in a school environment, students from disadvantaged groups. This socialization activity uses lecture methods, discussion and film visualization. The lecture method aims to provide a foundation of understanding of child-friendly school programs and discussion methods aimed at perfecting understanding. Film visualization method is given to strengthen the understanding of the community / students in the form of motivational impressions in order to want to implement this program. The output of the activity is the formation of child-friendly pilot elementary and junior high schools and public awareness of the needs of Child Friendly Schools in Kaur District.