Service Delivery Issues Research Articles

Implementation of Digital Transformation and Government Enterprise Architecture in Improving the Performance of Integrated Social Services

This study addresses the subject matter of declining public confidence in local governments in Indonesia, primarily due to issues in public service delivery, highlighting the urgent need for improved integrated social services. The objective is to analyze the mediating effect of enterprise architecture orientation on the influence of environmental turbulence, flexibility strategy, business model innovation, and digital transformation on social service performance in West Java. Methods involved a survey explanatory approach with all 27 social service providers in West Java Province, employing whole population sampling. Data were analyzed using descriptive statistical analysis and hypothesis testing using Partial Least Square Structural Equation Modeling (PLS-SEM). Results indicate that environmental turbulence, flexibility strategy, business model innovation, and digital transformation significantly impact social service performance when mediated by enterprise architecture orientation. The conclusions suggest that a robust model emphasizing strategic architectural orientation and effective implementation of flexibility, innovation, and digital transformation can enhance social service performance amidst environmental challenges. This study contributes to understanding the complex dynamics of social service provision in local governments, advocating for strategic investments in enterprise architecture and adaptive strategies to improve public service delivery and restore public trust.

Identity, experience, and non-partisan: the institution of traditional chiefs and development in a rural local municipality in North West Province, South Africa

ABSTRACT This paper explores the place and role of chiefs and their institution in the governance and development of rural society in South Africa, using a case study of six tribal authorities in the Moses Kotane Local Municipality, North West Province. It examines whether chiefs have taken active development roles in their communities, and how they are perceived by society vis-à-vis community councillors. It argues that active roles and endorsement by the people are evidence of the significance of chiefs in the rural governance structures. In the studied tribal authorities, chiefs assumed central development roles, by initiating development projects, mobilizing stakeholders, and providing information to their people that ensured compliance with government COVID-19 regulations. While development and service delivery issues are the mandate of the community councillors and council, people saw the chiefs as best suited to spearhead development in their areas, because of their proximity to society and knowledge of their needs. The paper argues that the institution of the chiefs constitutes an accountable leadership that acts in the interests of all people, and chiefs should be incorporated in rural governance structures.

The Study of the Components of the Excellent Service Provision of the Primary Educational Service Area Offices in the Office of the Basic Education Commission

Education plays a pivotal role in societal development and nation-building, particularly in the 21st century, marked by rapid changes and globalization. Ensuring quality education that meets the needs of both the job market and national development is paramount for Thailand’s vision of becoming a “Stable, Prosperous, and Sustainable Country” as outlined in its 20-year National Strategy (2018–2037). Within this framework, the Primary Educational Service Area Offices in the Office of the Basic Education Commission are tasked with providing essential educational services. However, various challenges, including resource inadequacy and service delivery issues, hinder their effectiveness. This research aims to investigate the components of the excellent service provision of the Primary Educational Service Area Offices in the Office of the Basic Education Commission, along with analysing the desired conditions, and the essential needs for providing excellent service. The study employs a mixed-methods approach, including literature review, expert consultations, questionnaire development, and data analysis. The research methodology has been conducted in two phases. Phase 1 of the research focuses on identifying the components of excellent service provision through a literature review and expert consultations. Six core components, including (1) the Development of Personnel Service Providers, (2) the Development of Service Procedures, (3) the Relationships Management with Service Recipients, (4) the Service Quality, (5) the Establishment of Service Culture, and (6) the Service Environment, Technology and Facilities, are identified and validated by the nine qualified experts. Phase 2 involves assessing the current conditions, the desired conditions, and the essential needs for service provision. Data collected from a sample group of 620 individuals across 124 Primary Educational Service Area Offices reveal high levels of current conditions and the highest levels of the desired conditions. The most essential need identified is the Development of Personnel Service Providers. The findings suggest that policies should be implemented to promote the development of personnel service providers and support the implementation of identified components for excellent service provision. Additionally, further qualitative research is recommended to compare service levels among different educational service areas and develop tailored models for excellent service provision.

Water Service Delivery Issues and Challenges for the Urban Poor Zones in South Western Uganda

The article aims to examine the issues and challenges associated with providing water services to urban impoverished areas in South Western Uganda. The research methodology employed in this study involved conducting a comprehensive desktop study and literature review, systematically searching, and selecting peer-reviewed journal articles, books, and conference proceedings within a specified scope, using carefully chosen keywords and search criteria. After collating and evaluating the selected literature, a thorough synthesis was done to identify existing knowledge gaps and provide insights into the research questions under investigation. The main findings of the results highlight the need for integrated service models to expand water service delivery for the urban poor zones in southwestern Uganda. The study concludes that the problems addressed in this research and the suggestions presented provide the basis for improving water services to urban impoverished areas in South Western Uganda. This research will broaden service models for urban areas while also creating service models for locations with features of impoverished conditions. It is crucial to remember that households in urban cells were more likely to use improved water sources (including piped water on-premises), make regular payments for water, rely on shared sanitation facilities, and use manual sludge emptying services

The Corporate Governance of South African State-Owned Enterprises (SOEs): Leadership and Compliance Issues

The financial, operational, and business issues facing SOEs have reduced the trust that investors and citizens have in the state's capacity to effectively promote national economic growth. Most countries, especially developing ones like South Africa, have been plagued by the issue of inadequate public service delivery. One key contributing factor to this problem has been identified as the poor governance practices of SOEs. The magnitude of these massive SOE business failures, which surpassed the failure of numerous other enterprises around the world, drew attention to the urgent need for new corporate governance studies. To contribute to this, the study explores the corporate governance of South African SOEs, with a focus on leadership and compliance. To achieve this, an online questionnaire was used to gather quantitative data from a sample of 288 internal audit professionals. The data collected was then analyzed using SPSS software, and descriptive statistics were employed to present the findings. The study found that corporate governance malpractices are common in SOEs, which include hiring managers and executives who lack the necessary qualifications and experience, high tender irregularities, and understaffing critical duties. This study is unique in that it employs stakeholder theory in an innovative approach to explain the findings, notably on the leadership issue. Besides, it contains critical recommendations for SOE leadership and policymakers on how to improve the corporate governance of SOEs to help them achieve their strategic goals, while also suggesting future study directions.

Poverty in South Africa: Drivers of Perpetuation

Poverty remains a persistent issue within the socio-political landscapes of Africa. This study explores the income, food, and multidimensional nature of poverty in South Africa. The study found that economic, social, and political factors are not only responsible for poverty, but they perpetuate poverty in South Africa. These factors include weak institutions, unemployment, service delivery issues, corruption, security challenges and dysfunctional family settings. The study adopted the state fragility theory to demonstrate how weaknesses in state institutions affect their ability to discharge their functions as expected and how they manage the dynamics associated with these expectations. The study utilised the qualitative research method based on literature search from secondary sources. These included journal articles, books, institutional documents, and newspaper articles. Data were descriptively analysed. The study recommends strong state institutions to coordinate stemming the threat these poverty drivers pose to the well-being of South Africans. It also recommends commitment through good values demonstrated by the political class, bureaucracies, and the citizens.

A Survey of Speech-Language Pathologists’ Knowledge and Perception About Their Role in Providing Dysphagia Services in India

Purpose: Speech-Language Pathologists (SLPs) are frequently involved in dysphagia services including identification, assessment, diagnosis, and rehabilitation. Understanding of SLPs’ role in dysphagia care has evolved drastically in India over the last decade; however, research and advocacy are still in emerging status. In order to refine dysphagia practice patterns in India, we should understand the current standards. Thus, the present study was conceived to investigate SLPs’ knowledge and perception about their role in providing dysphagia services in India.Methods: A cross-sectional online survey research design was employed. The survey questionnaire comprised of four sections that evaluated SLPs’ demographic characteristics, exposure to dysphagia services, self-perception about their role in the dysphagia rehabilitation team, and knowledge related to assessment and management of individuals with dysphagia. The obtained responses were stored in Google forms and were further analyzed in terms of percentage.Results: A total of 269 SLPs responded to the survey and 59% of the respondent SLPs practicing in India were rendering dysphagia services. Although a majority of the SLPs had adequate knowledge and were aware of their role in the interdisciplinary dysphagia rehabilitation, they lacked opportunities to be a part of the team.Conclusion: The survey clearly identified the trend and issues in dysphagia service delivery by SLPs in the Indian scenario by evaluating their knowledge and skills fundamental to the assessment and management of individuals with dysphagia. This further necessitates a re-examination of the role of SLPs in providing dysphagia services in India in view of establishing standard guidelines and practice patterns.

Improving Local Community Public Services: Revealing Hurdles and Strategic Remedies

This research investigates the complexities within public service delivery at the Buduran Sub-District Office in Sidoarjo Regency, identifying issues arising from intricate procedures and demanding requirements. The study aims to uncover and analyze factors impacting the improvement of public service performance, employing a SWOT analysis to identify internal and external environmental factors. The strategic identification of five critical issues emerges, including inadequate infrastructure, public unfamiliarity with service procedures, limited service personnel, suboptimal workforce competencies, and administrative disorder at the village level. Corresponding strategic responses are proposed, such as infrastructure enhancement, intensified public education on service procedures, capacity building for civil servants, specialized recruitment in service areas, and fortified coordination with village administrations. The implications suggest targeted strategies for policymakers and public service administrators to address these challenges, thereby elevating service quality and responsiveness to societal needs.
 Highlights:
 
 SWOT Analysis: Identifying Internal and External Factors - Essential for strategic planning and understanding the landscape of service delivery challenges.
 Critical Issues in Service Delivery: Infrastructure, Public Awareness, and Human Resources - Addressing these facets is pivotal for enhancing service quality and efficacy.
 Strategic Responses: Infrastructure Development, Public Education, and Workforce Capacity Building - Implementing targeted strategies to address identified challenges and fortify service delivery mechanisms.
 
 Keywords: Public Service, Performance Improvement, Strategic Solutions, SWOT Analysis, Community Engagement

Gender based violence (GBV) coordination in a complex, multi-crisis context: a qualitative case study of Lebanon’s compounded crises (2019–2023)

BackgroundSince 2019 Lebanon has faced multiple compounded crises. Political and social instability, the COVID-19 pandemic, and the Beirut Port explosion, alongside the influx of refugees related to the ongoing Syrian conflict, have resulted in a nationwide economic emergency. In the context of the humanitarian response to the Syrian conflict, the UN and government-led gender-based violence (GBV) task force has coordinated the sub-sector since 2012. The compounded crisis, however, created new challenges for GBV coordination and service delivery, which we explore in this paper. We highlight lessons for strengthening GBV coordination in Lebanon and other complex emergencies.MethodsWe conducted 29 remote in-depth interviews, reviewed key policy documents and observed seven GBV task force meetings. We analysed and presented our findings across three key themes: context-relevant and adaptable coordination mechanisms; coordination to support GBV service delivery; and stakeholders’ roles, legitimacy and power.ResultsParallel response frameworks developed to address the multiple crises, created a complex humanitarian architecture within an increasingly challenging operating context, with some perceived inefficiencies. Positively, coordination was integrated under the established government-UN interagency system and the GBV task force maintained GBV sub-sector coordination. The task force was commended for effectively adapting to the evolving context, including working remotely, maintaining essential GBV services, assessing the compounded crises’ impact on programming and adjusting accordingly, and harmonising guidance, tools and approaches. The importance of ensuring a government co-led response was highlighted by both UN and government informants, who pointed to examples where marginalising government leadership compromised coordination effectiveness and sustainability. The participation of local actors had become increasingly important but more difficult, with the impact of the various crises, and remote modalities, challenging service delivery and staff wellbeing.ConclusionExperiences from Lebanon highlight the essential role of government leadership in coordination; the value of investing in local GBV capacity; the significance of effective national, subnational and intersectoral coordination to support service delivery and address cross-cutting GBV issues; the importance of targeted interventions to support marginalised populations; and the need to prioritize the well-being of front-line staff during crisis response. In Lebanon, and other complex crises, donors are encouraged to increase flexible, multiyear funding for GBV coordination and services, while women-led organizations should be at the forefront of recovery efforts, contributing to a more equitable society.

Recognizing Traces of Colonialism and Coloniality in a South African Mining Region: Surfacing the Past in Regional, Ethnographic and Well-Being Research

Recent discussions on colonialism and coloniality in academic and community contexts have not been fully informed, only understanding the past from a present-day context. This article provides a deeper, more experiential understanding of this culturally complex phenomenon by combining three research methodologies: structured regional research, ethnography informed research and multidisciplinary wellbeing research. The article examines traces of colonialism in the Far West Rand area of South Africa, at a time of expanding mining operations when it was rare for people to think of themselves as ‘colonists’ with a colonial vision. Yet, structured regional research points to a history of immense urbanisation, linked to immigration and strong, almost dominant, features of colonialism. Two other, totally different, research methods have also observed the same phenomenon, adopting a more experiential angle to communities in the Far West Rand. These community experiences relate more closely to a coloniality imagery manifested primarily in ideas and opinions about contemporary service delivery, poverty and land use issues.

Applying Logic to the Healthcare Journey.

Cross-disciplinary approaches to remediate complex healthcare service delivery issues may have merit. This study aims to establish the potential benefits of applying service design and evaluative research concepts in healthcare. Specifically, this study aims to demonstrate how a Customer Journey Map and a Logic Model could be used in unison to identify and remedy service delivery gaps to reduce barriers to care. This study provides systems thinking approach to solving operational issues in healthcare.

An investigation into the effectiveness of public participation mechanisms on service delivery within the Newcastle local municipality

A little over two years ago, from the 9th to the 18th of July 2021, South Africa experienced one of the worst incidents of civil unrest since the beginning of its democratic dispensation. Although the main catalyst for this unrest was not directly issues of service delivery or public participation, many observers, experts or not could not help but see the connection to issues of poverty, unemployment and overall lack of service delivery. Public participation has long been established as a vital tool in the hands of the government for efficient service delivery & development. The Newcastle Local Municipality (NLM) as an institution in South Africa, is governed by numerous public participation legislation which essentially states it must always consult & involve all its citizens on all issues that affect the community at large. Despite its adherence to these stipulations, this brief study, through a qualitative inquiry making use of an interview schedule, finds that NLM practices a type of participation strategy known as “Degrees of tokenism” where the result is the appeasement and placation of the masses as opposed to true participation that gives the masses real power. The results indicated that the officials entrusted with ensuring the implementation of the public participation mandate faced numerous challenges that rendered their stellar efforts inefficient. Issues such as a lack of understanding of the fundamental importance of good governance and public participation led to a shortage of resources and increased apathy toward municipal affairs. In investigating the nature of the public participation framework in NLM the researcher aimed at providing more insight into the complex issues at play responsible for the largely concerning state of local government in South Africa, thus possibly providing solutions in the process.

Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study

SummaryThis qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide.IntroductionFracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare.MethodsQualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices.ResultsSeven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP–patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps.ConclusionKey challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide.

Stuttering management practices in Sri Lanka: A mixed method study

PurposeSpeech and language therapy is a growing profession in Sri Lanka, and little is known about how stuttering is currently managed in the country. Therefore, this study aimed to investigate the current stuttering management practices in Sri Lanka and to investigate any barriers to service provision. MethodA convergent mixed methods design was employed across two phases. Sixty-four Sri Lankan speech and language therapists (SALTs) participated in online surveys in phase one and ten participated in semi structured interviews in phase two. Survey data in phase one was analysed using descriptive statistics and data in phase two was analysed using thematic analysis. Results from both phases were triangulated for the overall interpretation of the data. ResultsSri Lankan SALTs conduct a comprehensive assessment, however some assessment contexts (e.g., stuttering beyond the clinic) were not routinely considered. Speech and language therapists reported using multiple and varied intervention approaches/strategies, which were often adapted and/or combined. It was noted that the delivery of treatment was more challenging. Barriers identified were including limited knowledge of some aspects of stuttering management, limited access to resources, and workplace constraints. ConclusionOverall, findings revealed that most Sri Lankan SALTs employ a comprehensive and holistic approach in assessment; however, some limited knowledge of the disorder and intervention was identified. Findings highlighted the need for further training for SALTs regarding the management of stuttering, the need for culturally and linguistically validated appropriate assessments as well as the need to consider logistical issues in clinical settings and service delivery.

DURATION OF IN-PATIENT PHYSICAL THERAPY AT A TERTIARY HOSPITAL: IMPLICATIONS OF A TIME AND MOTION STUDY

Introduction: In-patient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eighthour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume nonclinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience. Methods: A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included. Results: Nineteen physical therapists with a mean experience of 54.53 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30, respectively. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p = 0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation. Discussion: Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

Investigating librarians’ intention to use artificial intelligence for effective library service delivery: A partial least square-structural equation modeling-based approach

Due to the information exploration coupled with the increased number of library users across the globe, servicing the users efficiently and in a simple manner became difficult, leading librarians to think of a better alternative. Artificial intelligence is one of the best options to mitigate issues of inefficient service delivery but has not been used enough in most Nigerian academic libraries and specifically North-eastern Nigerian academic libraries. This research, therefore, aims at examining the factors that can influence the librarians’ intention to use artificial intelligence in their libraries for better and more efficient service delivery to library patrons using the theoretical lenses of the Theory of Plan Behaviour (TPB). A quantitative method using a cross-sectional approach was adopted and a questionnaire was used as an instrument for data collection. Three federal university libraries from North-eastern Nigeria were covered and 242 professionals and para-professionals librarians composed the population of the research. G*Power application was used to estimate the minimum sample size of the research amounting to 119 samples thus, a proportionate stratified random sampling technique was used in obtaining the sampling. Statistical Package for Social Science (SPSS) version 20 and Partial Least Square – Structural Equation Modelling (PLS-SEM) were used to analyze the data. The findings revealed that TPB’s theoretical variables were positively significant factors that influenced the librarians’ intention to use Artificial Intelligence in their respective libraries. Equally, the finding further revealed that the librarians indicated a high intention to use artificial intelligence in their libraries. The use of more advanced theory, the inclusion of more samples and considering a specific artificial intelligence tool were recommended for future research.

Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa.

Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti. Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles. Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered.Contribution:This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research.

An analysis of KwaZulu-Natal clinical psychologists’ multicultural experience

In this article, perspectives of South African clinical psychologists (based in KwaZulu-Natal) regarding multicultural issues in clinical practice and training are presented. The discussion focuses on emergent themes from 13 qualitative semi-structured interviews. Themes from interviews were analysed using thematic analysis and techniques from a grounded theory approach. While the study focused on a number of contextual multicultural issues both in service delivery and in training, this article documents the experiences of clinical psychologists regarding multicultural challenges and concerns, as well as approaches and capacities used to improve service delivery in this area. These perspectives are important in the multicultural and multilingual South African context, where there is limited literature in this area as well as related aspects such as cultural competency. There are many different belief systems as well as historical and sociopolitical factors that may influence how clinicians and individuals presenting for treatment may understand their experience and symptoms. This article seeks to document some of the challenges this may present in terms of service delivery in this context. Understandings of the term cultural competence as well as suggestions (primarily as noted by participants) to address the gap between training, competencies, and the realities of service delivery are also presented. Questions and considerations for future research are also raised.

Co-creation and self-evaluation: An accountability mechanism process in water, sanitation and hygiene services delivery in childcare centres in Nairobi's informal settlements.

Accountability strategies are expected to enhance access to water, sanitation and hygiene (WASH) service delivery in low-and middle-income countries (LMIC). Conventional formal social accountability mechanisms (SAMs) for WASH service delivery have been inadequate to meet the needs of residents in informal settlements in LMICs. This has prompted growing interest in alternative informal SAMs (iSAMs) in Nairobi's informal settlements. To date, iSAMs have shown a limited effect, often due to implementation failures and poor contextual fit. In childcare centers in Nairobi's informal settlements, co-creation of the iSAMs process, where parents, childcare managers, researchers and other WASH stakeholders, contribute to the design and implementation of iSAMs, is an approach with the potential to meet urgent WASH needs. However, to our knowledge, no study has documented (1) co-creating iSAMs processes for WASH service delivery in childcare centers and (2) self-evaluation of the co-creation process in the informal settlements. We used a qualitative approach where we collected data through workshops and focus group discussions to document and inform (a) co-creation processes of SAMs for WASH service delivery in childcare centers and (b) self-evaluation of the co-creation process. We used a framework approach for data analysis informed by Coleman's framework. Study participants co-created an iSAM process that entailed: definition; action and sharing information; judging and assessing; and learning and adapting iSAMs. The four steps were considered to increase the capability to meet WASH needs in childcare centers. We also documented a self-evaluation appraisal of the iSAM process. Study participants described that the co-creation process could improve understanding, inclusion, ownership and performance in WASH service delivery. Negative appraisals described included financial, structural, social and time constraints. We conclude that the co-creation process could address contextual barriers which are often overlooked, as it allows understanding of issues through the 'eyes' of people who experience service delivery issues. Further, we conclude that sustainable and equitable WASH service delivery in childcare centers in informal settlements needs research that goes beyond raising awareness to fully engage and co-create to ensure that novel solutions are developed at an appropriate scale to meet specific needs. We recommend that actors should incorporate co-creation in identification of feasible structures for WASH service delivery in childcare centers and other contexts.

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study.

Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (-0.15; p < 0.01), longer SSD diagnosis (-0.16; p < 0.01), higher collaboration (-0.16; p < 0.01) and lower symptomatology (-0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.