Roll-out Process Research Articles

Hybrid Network–Spatial Clustering for Optimizing 5G Mobile Networks

5G is the new generation of 3GPP-based cellular communications that provides remarkable connectivity capabilities and extreme network performance to mobile network operators and cellular users worldwide. The rollout process of a new capacity layer (cell) on top of the existing previous cellular technologies is a complex process that requires time and manual effort from radio planning-engineering teams and parameter optimization teams. When it comes to optimum configuration of the 5G gNB cell parameters, the maximization of achieved coverage (RSRP) and quality (SINR) of the served mobile terminals are of high importance for achieving the very high data transmission rates expected in 5G. This process strongly relies on network measurements that can be even more insightful when mobile terminal localization information is present. This information can be generated by modern algorithmic techniques that act on the cellular network signaling measurements. Configuration algorithms can then use these measurements combined with location information to optimize various cell deployment parameters such as cell azimuth. Furthermore, data-driven approaches are shown in the literature to outperform traditional, model-based algorithms as they can automate the optimization of parameters while specializing in the characteristics of each individual geographical zone. In the context of the above, in this paper, we tested the automated network reconfiguration schemes based on unsupervised learning and applied statistics for cell azimuth steering. We compared network metric clustering and geospatial clustering to be used as our baseline algorithms that are based on K-means with the proposed scheme—hybrid network and spatial clustering based on hierarchical DBSCAN. Each of these algorithms used data generated by an initial scenario to produce cell re-configuration actions and their performance was then evaluated on a validated simulation platform to capture the impact of each set of gNB reconfiguration actions. Our performance evaluation methodology was based on statistical distribution analysis for RSRP and SINR metrics for the reference scenario as well as for each reconfiguration scheme. It is shown that while both baseline algorithms improved the overall performance of the network, the proposed hybrid network–spatial scheme greatly outperformed them in all statistical criteria that were evaluated, making it a better candidate for the optimization of 5G capacity layers in modern urban environments.

LOKO: Localization-aware Roll-out Planning for Future Mobile Networks

The roll-out phase of the next generation of mobile networks (5G) has started and operators are required to devise deployment solutions while pursuing localization accuracy maximization. Enabling location-based services is expected to be a unique selling point for service providers now able to deliver critical mobile services, e.g., autonomous driving, public safety, remote operations. In this paper, we propose a novel roll-out base station placement solution that, given a Throughput-Positioning Ratio (TPR) target, selects the location of new-generation base stations (among available candidate sites) such that the throughput and localization accuracy are jointly maximized. Moving away from the canonical position error bound (PEB) analysis, we develop a realistic framework in which each positioning measurement is affected by errors depending upon the actual wireless channel between the measuring base station and the target device. Our solution, referred to as LOKO, is a fast-converging algorithm that can be readily applied to current 5G (or future) roll-out processes. LOKO is validated by means of an exhaustive simulation campaign considering real existing deployments of a major European network operator as well as synthetic scenarios.

Evaluating a mobile-based short virtual course on family planning for frontline health workers in India

One of the ways to address the critical gap of trained human resources in health is to train frontline workers (FLW) on health prevention and health promotion. The FLW play an important role in community mobilization, outreach activities, and service delivery at the last mile. In rural India, the number of internet and smartphone users is rapidly increasing, presenting an opportunity to reach and virtually train FLW. The current evidence base shows progress towards creating and using mobile-based training, but significant work is needed to improve the quality of mobile-based training programs. This study showcases Project Samvad’s experience in creating and rolling out a virtual training course for FLW, highlighting the feasibility of virtual training at scale and the quality of engagement of the participants with the course content. The method for this descriptive study is divided into two broad categories: (i) course development, promotion, and rollout processes, and (ii) course evaluation. Both qualitative and quantitative approaches were used to collect and analyze data. We found that the overall average course completion rate was 82% (992 out of 1211 registrants). The average increase in the endline question accuracy was around 15 percentage points from the baseline. We conclude that mobile-based virtual training of FLW is feasible and program managers and policymakers should consider creating hyperlocal course content, ensure participation of partners at various stages of development and rollout of the course and use a peer-to-peer and community-led system to support the learners.

Avoiding pitfalls: Key insights and lessons learnt from customizing and rolling out a national web‐based system in Tanzania

AbstractTanzania is among the first countries to adopt District Health Information System version 2 (DHIS2) as the national health management information system (HMIS). In this article, we share experiences on achievements and challenges encountered in the process of customizing and rolling out the DHIS2 in Tanzania. This instrumental case study was conducted using a qualitative approach involving desk reviews, key informant interviews, and field observations. Tanzania successfully adopted the DHIS2 as evidenced by innovation of new apps; improving availability of quality data and enhancing data analysis. These achievements were attributed to inbuilt system strengths that provided the necessary flexibility for customization; the use of local experts to customize and maintain the system; cascaded training; and formation of a consortium to coordinate and support the rollout process. Prior existence of a robust paper‐based HMIS and lessons from other countries' experience favored smooth transition. However, several challenges hindered the DHIS2 implementation including donor dependency and ineffective cascade training that left many users untrained. Countries envisaging to adopt the DHIS2 need to consider the use of cost‐effective training approaches to accommodate all users including the use of champions to conduct on‐the‐job training, support, and mentoring.

The Environment, Leiomyomas, Latinas, and Adiposity Study: rationale and design

Uterine leiomyomas, commonly known as fibroids, are benign tumors in postmenarchal females. By the age of 35 years, approximately 30% of females will have fibroids, and by the age of 50 years, the prevalence approaches 70% with some studies reporting >85% prevalence in African American females. Previous studies evaluating the prevalence of fibroids have largely relied on self-reported fibroid diagnoses, which could have falsely underestimated prevalence because many females with fibroids are asymptomatic. Despite known differences in fibroid prevalence by race, there are very limited data on fibroid prevalence by ethnicity. The Latino population is the largest ethnic minority in the United States, yet there is no large study that utilizes ultrasound to confirm the presence of fibroids in Latina/Latinx females. In addition, fibroids have been associated with obesity and with diabetes mellitus, but the data have been inconsistent and at times conflicting. The Environment, Leiomyomas, Latinas, and Adiposity Study was designed to quantify the prevalence of uterine fibroids among Latina/Latinx females and understand the relationships between obesity, glucose dysregulation, and fibroid prevalence and growth. This article presents the study's design and reports early enrollment data. The Environment, Leiomyomas, Latinas, and Adiposity Study is a 5-year longitudinal cohort study based in Southeast Michigan with the goal of recruiting 600 Latina/Latinx females between the ages of 21 and 50 years. Given the recruitment goals, developing a respectful, transparent, and trusting relationship between the study investigators and the community was a major priority. Thus, a community-engaged research approach was utilized in the design of the Environment, Leiomyomas, Latinas, and Adiposity Study. A community advisory board containing community leaders, largely from the Latinx community, provided input and direction during the entirety of the Environment, Leiomyomas, Latinas, and Adiposity Study design and rollout process. A minimum of 3 visits (orientation and consent, baseline, follow-up) will be conducted for each participant, with baseline and follow-up visits approximately 18 to 30 months apart. At each visit, interviewer and self-administered surveys will assess sociodemographic factors, health behaviors, health history, and social determinants of health. In addition, participants undergo a pelvic ultrasound examination and biologic samples are collected. Using community-engaged approaches, we have successfully enrolled 633 Latina/Latinx females. The mean participant age is 37.5±7.04 years. The mean body mass index is 30.0±6.54 kg/m2. First study visits have been initiated. The objective of the Environment, Leiomyomas, Latinas, and Adiposity Study is to address the knowledge gap regarding uterine fibroids in the Latina/Latinx population. The Environment, Leiomyomas, Latinas, and Adiposity Study will generate ultrasound-confirmed evidence of the prevalence and growth patterns of uterine fibroids in this specific population while also examining the associations between obesity and laboratory-confirmed glucose dysregulation with uterine fibroid prevalence and growth patterns.

COVID-19 Vaccine Website Accessibility Dashboard

Background: The COVID-19 pandemic has exacerbated historical inequities for people with disabilities. This includes barriers in accessing online information and healthcare appointment websites, which were brought to the foreground during the vaccine rollout and registration process. Methods: The Johns Hopkins Disability Health Research Center created a COVID-19 Vaccine Dashboard, which compiled COVID-19 information and vaccine registration web pages from 56 states and territories in the United States (U.S.) from March 30 through April 5, 2021 and analyzed accessibility using WAVE Web Accessibility Evaluation Tool (WAVE). This tool identifies website accessibility barriers, including insufficient contrast, alternative text, unlabeled buttons, total number of errors, and error density. COVID-19 information and vaccine registration web pages were ranked and grouped into three groups by number of errors, creating comparisons between states on accessibility barriers for people with disabilities. Findings: All 56 U.S states and territories had COVID-19 information web pages and 29 states had centralized state vaccine registration web pages. Total errors, error density, and alert data were utilized to generate accessibility scores for each web page, the median score was 259 (range=14 to 536 and IQR=237) for information pages, and 146 (range=10 to 281 and IQR=105) for state registration pages. Interpretation: These results highlight the barriers that people with disabilities may encounter when accessing information and registering for the COVID-19 vaccine, which underscore inequities in the pandemic response for the disability community and elevate the need to prioritize accessibility of public health information. Funding: American Association of People with Disabilities (AAPD) Declaration of Interest: All authors declare no competing interests.

Managing Two-Dose COVID-19 Vaccine Rollouts with Limited Supply

Distributing scarce resources such as COVID-19 vaccines is often a highly time-sensitive and mission-critical operation. On top of that, most COVID-19 vaccines require two doses to be administered three or four weeks apart. How to effectively roll out two-dose vaccines is a crucial policy decision given that many countries are struggling with limited supply and facing mounting pressure to slash hospitalizations and mortality and to rapidly achieve herd immunity through vaccination. In this paper, we first model and analyze inventory dynamics of the rollout process under three rollout strategies: (1) holding back second doses, (2) releasing second doses, and (3) stretching the lead time between doses. Then we develop an SEIR model that incorporates COVID-19 asymptomatic and symptomatic infections to evaluate these strategies in terms of infections, hospitalizations, and mortality.Among our findings, we show releasing second doses reduces infections but creates uneven vaccination patterns. In addition, to ensure second doses are given on time without holding back inventory, strictly less than half of supply can be allocated to first-dose appointments. Stretching the between-dose lead time flattens the infection curve and reduces both hospitalizations and mortality compared with the strategy of releasing second doses. We also consider an alternative single-dose vaccine with a lower efficacy and show the vaccine can be more effective than its two-dose counterparts in reducing infections and mortality. We conduct extensive sensitivity analyses related to age composition, risk-based prioritization, supply disruptions, and disease transmissibility. At a time when many countries, especially in the developing world, face stringent vaccine supply constraints, our research provides important implications for policymakers to develop effective vaccine rollout strategies. More broadly, our paper sheds light on how to develop effective operations strategies for distributing time-sensitive resources in times of crises.

P051 Rollout of Kaftrio® to adult cystic fibrosis patients at the Royal Brompton Hospital during a global pandemic

Objectives: To review the rollout process for Kaftrio® at this large adult CF Centre following approval by the European Medicines Agency (EMA) in June 2020, EMA marketing authorisation and commissioning by NHS England on 21st August 2020, taking into consideration the limitations imposed on clinical services due to COVID-19. Methods: Recent rollout of Symkevi® meant that this adult CF service had already developed processes for the identification of suitable patients and medication distribution. Due to COVID-19 restrictions, innovative methods for clinical review, patient discussion, testing for liver function and occasionally genotype were developed. Furthermore, contract extensions and new paperwork for Homecare companies had to be produced as medication was delivered to patients’ homes. This established process involving multidisciplinary digital consultations, Bluetooth spirometry and self-administered postal blood tests was therefore replicated. Additionally, to ensure access for as many patients as possible we re-checked some genetic mutation results, especially where diagnosis pre-dated current testing technology. Results: This table shows the rate at which our patients were able to access Kaftrio®. Two thirds of patients had access to Kaftrio® a month after it was commissioned and 265 of the 348 eligible patients were taking Kaftrio® within 2 months. [Table presented] Conclusion: Using our experience from the launch of Symkevi®, we were able to adapt to this much larger rollout to despite the limitations imposed by the pandemic. To ensure that patients would benefit from early access we started putting processes in place before Kaftrio® was licensed by the EMA. As soon as commissioning was announced by NHS England, we were ready to start prescribing. This allowed our patients to access Kaftrio® very quickly with 144 out of 348 eligible patients taking their initial dose just over 2 weeks later and 286 patients on treatment after just over 2 months.

A System Approach to Therapeutic Packing

Unintended retained foreign objects (UNFOs) remain the most reported sentinel event to The Joint Commission in 2017 and 2018. Steelman et al. reported that 10% of RFOs included intentionally placed packing that was to be removed at a later time. Most efforts to decrease RFOs have focused on items such as needles and sponges; however, the retention of intentionally placed objects like therapeutic packing remains a challenge that has attracted less attention. Moving toward a “zero-harm” culture and committed to providing safe passage, Baylor Scott & White HealthCare System (BSWH) recognized the need to standardize the policy and process of intentionally placed therapeutic packing. Benchmarking with other facilities regarding successful therapeutic-packing processes directed BSWH to develop a standardized practice throughout each facility. This led to decreased retention of therapeutic packing and provided safe passage for all patients. The current RFO policy was revised and presented to systemwide nursing and physician councils. PowerPoint presentations reviewed the identification of patients with therapeutic packing, the process of communicating therapeutic-packing placement, and the removal of the packing. Standardized documentation of therapeutic packing in the electronic health record were shared across all facilities. All patients with therapeutic packing in place received an orange armband and education regarding the armband’s significance. Nurses used orange tracking sheets to identify patients with therapeutic packing in place. On removal of the packing, the orange armband was removed. Nursing leaders performed audits to ensure compliance with all policies and processes. Rollout included bedside-education leaders who championed the process; however, implementation was not consistent. Therefore, additional educational luncheons, e-mails, and one-on-one communication helped to reiterate the process. Compliance immediately after the policy was 71.4% and has now improved to 100%. Since the implementation of the therapeutic-packing process, we have not had any RFOs throughout the health care system. Involvement of bedside nursing is imperative for a successful rollout process. Use of unit champions to assist in rollout and solicitation of ongoing staff feedback on the standardized approach improved staff buy-in, which contributed to a quicker and more successful implementation.

Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study.

BackgroundElectronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation.ObjectiveThis study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts.MethodsAn ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit.ResultsOur program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care.ConclusionsOur program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care.

The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.

Addressing comprehensive primary healthcare in Gujarat through mHealth intervention: Early implementation experience with TeCHO+ programme.

Background:The Health and Family Welfare Department of Gujarat implemented a mHealth Programme called TeCHO+ (Technology for Community Health Operations) in 2018. TeCHO+ is aimed at making progress across all dimensions of the comprehensive primary healthcare services.Objective:The objective of this study is to record the document rollout and early implementation experience of TeCHO+ programme in Gujarat.Methods:The present participatory process documentation exercise was undertaken in Gujarat. The various steps for process documentation were decided after participation in multiple task force meetings and state/district- and taluka-level action seminars and reviewing the TeCHO+ programme data and progress reports. The perceptions of the health officials and field staff were gathered using key informant interviews from five districts of Gujarat: Bharuch, Narmada, Gandhinagar, Mahisagar, and The Dangs. In addition, stakeholders involved with TeCHO+ Programme were interviewed to understand the process of rollout, implementation challenges, and success.Results:In the initial phase, the TeCHO+ application focussed only on updating the Family Health Survey to improve the quality of data captured in the system. FHWs log-in the mobile application daily to access their daily work plan for which SMS alerts were are also generated. Most FHWs were in their 50s and were first-time smartphone users. Although, they were enthusiastic and open to the new technology, initially they faced certain difficulties in operating the application. The programme had a strong troubleshooting mechanism in terms of the use of WhatsApp group, helpline numbers, and voice calls in addition to supportive supervision.Discussion:TeCHO+ showed the potential to enhance the quality of the collected data and also service coverage. However, poor technology literacy of old FHWs, the launch of multiple programme memes at the same time, and target-driven task assignments pose major challenges.

Schooling and Labor Market Impacts of Bolivia's Bono Juancito Pinto Program

Schooling and Labor Market Impacts of Bolivia's <i>Bono Juancito Pinto</i> Program

Pharmacists' perceptions of implementing a pharmacist‐managed area under the concentration time curve‐guided vancomycin dosing program at a large academic medical center

IntroductionA pharmacist‐managed area‐under the concentration time curve/minimum inhibitory concentration (AUC/MIC)‐based vancomycin dosing and monitoring strategy was implemented at the University of Maryland Medical Center (UMMC) in January 2017. Because this was a large change in practice and methodology, we sought to understand pharmacists' perceptions of the practice before and after implementation.MethodsA mixed methods preimplementation survey was sent to all pharmacists, including residents, completing vancomycin dosing training at UMMC 1 month prior to transition to an AUC‐guided pharmacist‐to‐dose practice. The postimplementation survey was subsequently sent 8 months after program rollout to the same study participants.ResultsA total of 127 responses completed the survey: 78 in the preimplementation and 49 in the postimplementation arm. Clinical specialist pharmacists represented 53.8% vs 49.0%, clinical pharmacists represented 32.1% vs 36.7%, and residents represented 14.3% vs 14.1%, respectively. Prior to implementation, 42.3% responded that AUC/MIC was the ideal pharmacokinetic/pharmacodynamic parameter, compared with 93.9% postimplementation (P &lt; 0.0001). Weight‐based dosing was primarily used preimplementation as opposed to postimplementation (46.2% vs 6.1%; P &lt; 0.0001). The average time spent evaluating a vancomycin dose increased from 8 (interquartile range [IQR] 5‐15) minutes to 15 (IQR 10‐17.5) minutes (P &lt; 0.0001). Respondents strongly agreed that pharmacist‐to‐dose AUC/MIC vancomycin for working at the top of their degree (53.1% preimplementation vs 61.5% postimplementation; P = 0.261). Main concerns regarding changes in vancomycin dosing practices included lack of pharmacist competency, which decreased after rollout (48.7% preimplementation vs 24.5% postimplementation; P = 0.081). Before implementation, respondents felt that practice problems and training sessions (69.2%) and computer decision support (57.7%) would be key to a successful rollout. Satisfaction with the rollout increased postimplementation (26.9% vs 49.0%, respectively P = 0.011).ConclusionPharmacists were in support of pharmacist‐to‐dose AUC vancomycin dosing practices, but there were concerns regarding competency. Training sessions with practice problems and integrated clinical decision support improved the rollout process.

Swapped Sectors Detection Based on User Location During Inter-Site Handovers

Network roll-out is a process composed of several actions, which, if not completed correctly, may degrade the final system performance. A common error during the roll-out process is the case in which feeders from baseband units to radio units or feeders from radio units to antennas are interchanged. Consequently, in sectorized sites, the service areas of two or more co-sited cells become swapped, affecting the initial network design. This paper proposes to utilize the location of the user during mobility procedures to enhance the state-of-the-art methods to detect swapped sectors automatically. There are multiple solutions to obtain the location of subscribers in mobile communications networks. However, the most accurate ones are either costly or not possible in current networks. Therefore, this paper addresses the problem of applying time-of-arrival techniques based on multilateration in present-day mobile networks by proposing an alternative using standardized signaling. One of the main benefits of the proposed method is its ease of being implemented in real networks without adding additional costs to the operators. Finally, the results are presented to demonstrate that the proposed method improves the performance of state-of-the-art methods.

Creating innovative products with reference system elements - a case study on approaches in practice

As any other human being development engineers preferably act based on experience. Hence it is comprehensible that even for a product that initially appears revolutionary usually one or more references can be found. This enhances, for example, the comparability or the availability of a products subsystems so that they are more easily to deal with. Especially during the development of a new product, which means the start of a new product line, the use of reference system elements helps to reduce development efforts. Reference system elements are, for example, physical products whose functions or components are relevant for one’s own product. By scanning the system of objectives for smaller subsystems one may find those functions or components just mentioned. For this scientific work a development process of a technology rollout was examined. The objective pursued was to gain insights on possibilities and challenges of deriving knowledge from such reference system elements in this specific case. A suitable research environment was offered by a medium sized machine manufacturer. A new technology to process foam particles using radio frequency is being developed there. The established process using steam is already in the high-end range, which is why only a small development potential is left. From the findings in this case study in synthesis with the state of the art on innovation management and knowledge management a descriptive process model is derived. The focus of the process model is to support the search for relevant reference system elements. For the examined machine, for example, the common microwave was used as a reference element. The elements found can be evaluated for their suitability using previously elaborated validation criteria. This facilitates the adoption of existing solutions or the development of new solutions based on reference system elements.

The Implications of Partially Using Internal Risk Models: Evidence from European Panel Data

In most countries, banks gradually rollout the internal ratings-based approach (IRBA) across credit risk exposures. My analysis reveals that some banks, called non-rollout banks, apply the IRBA only partially for several years and therefore are able to save implementation costs compared to rollout banks. Further, I find a non-monotonic relation between the IRBA coverage ratio and risk-weight densities: Banks firstly implement IRBA for those portfolios that promise the highest reduction in risk-weighted assets (RWA). Overall, the results suggest that non-rollout banks implement the IRBA (only) for exposures for which implementation costs are (over-) compensated by RWA savings. Moreover, I show that an incomplete rollout process is associated with a lower loan quality, which contradicts the purpose of policy makers to introduce internal models as a comprehensive risk governance tool.

Improving the Labor Market Outcomes of US Veterans: The Long-Run Effect of the Transition Assistance Program

ABSTRACTThe success of military recruiting depends largely on the potential consequences of military services. This study examines how military service affects labor market outcomes of veterans. Specifically, I focus on how the Transition Assistance Program (TAP), a career assistance program, help military personnel transition to the civilian labor market. To identify the effects of TAP, I exploit variation in program accessibility generated by its initial rollout process. Using data from the Current Population Survey, I find that TAP improves the labor market outcomes of veterans, measured approximately ten years after separation. Specifically, it leads a significant increase in labor force participation. One possible mechanism is that TAP encourages the use of the GI Bill, a program that provides financial assistance to attend institutions of higher education.

Use of District Health Information System (DHIS-2) for Real Time Surveillance: Lebanon 2017

Background: The Ministry of Health in Lebanon is in the process of migrating surveillance reporting from a cumbersome paper-based system to a web-based electronic platform (DHIS-2). Objective: The aim of the project is to have real-time information flows in order to timely detect alerts and outbreaks in order to take quickest action. Methods: DHIS-2 tool was initially piloted in Lebanon in 2014 for school-based surveillance. In May 2017, the tool was extended progressively for other surveillance programs collecting aggregate data from hospitals, medical centers, dispensaries and laboratories. As part of the roll-out process, the online application was developed: customized aggregated-based datasets, organization units, accounts users and generic dashboards. 80 training sessions targeting 1290 users were conducted throughout the country. Those trained included 35 district and province health officers, 150 focal persons working in all public and private hospitals, 140 focal persons in laboratories and 800 in medical centers and dispensaries. To assess improvements in surveillance reporting, we compare completeness and timeliness for reporting for the period before and after the implementation of DHIS2. Challenges and lessons learned during the roll-out process are documented. Results: For laboratory-based surveillance, completeness of reporting increased from 70.8% in May to 89.6% in October. Timeliness has improved from 25% to 74%. For medical centers an improvement of 8.1% in the reporting and 9.4% in the timeliness is recorded before and after training sessions. For zero reporting, completeness remains the same (88%) and timeliness has improved from 74% to 87%. There was also increase in the reporting of communicable diseases. Implementation challenges included limited access to internet (29%) and limited workforce (21%). Conclusions: Implementation of DHIS2 resulted improvement in timeliness and completeness for aggregated data reporting. Continued onsite support, monitoring and system enhancement included internet connectivity are needed to enhance the performance of DHIS2.

Messiness of forest governance: How technical approaches suppress politics in REDD+ and conservation projects

Abstract Reduction of Emissions from Deforestation and Forest Degradation (REDD+) was originally conceived to address the global problem of climate change by reducing deforestation and forest degradation at national and subnational levels in developing countries. Since its inception, REDD+ proponents have increasingly had to adapt global ideas to local demands, as the rollout process was met with on-the-ground realities, including suspicion and protest. As is typical in aid or ‘development’ projects conceived in the global North, most of the solutions advanced to improve REDD+ tend to focus on addressing issues of justice (or ‘fairness’) in distributive terms, rather than addressing more inherently political objections to REDD+ such as those based on rights or social justice. Using data collected from over 700 interviews in five countries with both REDD+ and non-REDD+ cases, we argue that the failure to incorporate political notions of justice into conservation projects such as REDD+ results in ‘messiness’ within governance systems, which is a symptom of injustice and illegitimacy. We find that, first, conservation, payment for ecosystem services, and REDD+ project proponents viewed problems through a technical rather than political lens, leading to solutions that focused on procedures, such as ‘benefit distribution.’ Second, focusing on the technical aspects of interventions came at the expense of political solutions such as the representation of local people’s concerns and recognition of their rights. Third, the lack of attention to representation and recognition justices resulted in illegitimacy. This led to messiness in the governance systems, which was often addressed in technical terms, thereby perpetuating the problem. If messiness is not appreciated and addressed from appropriate notions of justice, projects such as REDD+ are destined to fail.