Situational Analysis Tool Research Articles

IMPROVEMENT OF THE INNOVATION POLICY OF WORLD CORPORATIONS AS A FACTOR FOR SUSTAINABLE DEVELOPMENT

The transition to a green economy is an inevitable direction of development, requiring activation of efforts for improvement of the environmental friendliness of the economies of all countries of the world economy. The article objective resides in the study of conditions and factors, identification of the models and mechanisms of the innovation activity of the transnational corporations. The methodological foundation of the research included the historical and logical method, methods of quantitative and qualitative comparisons (when determining the cross-cultural peculiarities of the innovation activity models in different countries, and methods of expert assessment and forecasting (SPAСE-analysis). The authors improved the scientific and methodological approach to the justification of the mechanism of development and introduction of the innovation policies of the world automobile corporations in conditions of a low-carbon economy by adjusting the objectives of the innovation policies of automobile corporations and eliminating problems in the process of policies implementation into the company’s activity. They developed innovations management strategies at the US automobile companies based on the strategic situation analysis tool – SPACE-analysis. They also recommended the use of a strategy of aggressiveness for quick reduction of costs and increase of profits in a short time.

Scaling up Surgical Capacity in Kenya: The Kenya Hospital Assessment Tool (K-HAT)

IntroductionAlthough substantial progress has been achieved to bring surgical care to the forefront of global health discussions, a number of low-and middle-income countries are still in the process of developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). This paper describes the initial step toward the development of the NSOAP through the creation of the Kenya National Hospital Assessment Tool (K-HAT). MethodsA study protocol was developed by a multisectoral collaborative group that represented the pillars of surgical capacity development in Kenya. The K-HAT was adapted from two World Health Organization (WHO) tools: the Service Availability and Readiness Assessment tool and the Situational Analysis Tool. The survey tool was deployed on Open Data Kit, an open-source electronic encrypted database. This new locally adapted tool was pilot tested in three hospitals in Kenya and subsequently deployed in Level 4 facilities. ResultsEighty-nine questions representing over 800 data points divided into six WHO Health Systems Strengthening sections comprised the K-HAT which was deployed to over 95% of Level 4 hospitals in Kenya. When compared to the WHO Service Availability and Readiness Assessment tool, the K-HAT collected more detailed information. The pilot test team reported that K-HAT was easy to administer, easily understood by the respondents, and that it took approximately 1 hour to collect data from each facility. ConclusionsThe K-HAT collected comprehensive information that can be used to develop Kenya's NSOAP.

Child eye health in Ethiopia: a mixed methods analysis of policy and commitment to action

BackgroundChild eye health is a serious public health issue in Ethiopia, where children under the age of 15 account for over half of the population. Our aim was to review...

A situational analysis of ear and hearing care in South Korea using WHO ear and Hearing Care Situation Analysis tool.

The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care. The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector. There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training. Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO.

Protocol for establishing a model for integrated influenza surveillance in Tamil Nadu, India.

The potential for influenza viruses to cause public health emergencies is great. The World Health Organisation (WHO) in 2005 concluded that the world was unprepared to respond to an influenza pandemic. Available surveillance guidelines for pandemic influenza lack the specificity that would enable many countries to establish operational surveillance plans. A well-designed epidemiological and virological surveillance is required to strengthen a country's capacity for seasonal, novel, and pandemic influenza detection and prevention. Here, we describe the protocol to establish a novel mechanism for influenza and SARS-CoV-2 surveillance in the four identified districts of Tamil Nadu, India. This project will be carried out as an implementation research. Each district will identify one medical college and two primary health centres (PHCs) as sentinel sites for collecting severe acute respiratory infections (SARI) and influenza like illness (ILI) related information, respectively. For virological testing, 15 ILI and 10 SARI cases will be sampled and tested for influenza A, influenza B, and SARS-CoV-2 every week. Situation analysis using the WHO situation analysis tool will be done to identify the gaps and needs in the existing surveillance systems. Training for staff involved in disease surveillance will be given periodically. To enhance the reporting of ILI/SARI for sentinel surveillance, trained project staff will collect information from all ILI/SARI patients attending the sentinel sites using pre-tested tools. Using time, place, and person analysis, alerts for abnormal increases in cases will be generated and communicated to health authorities to initiate response activities. Advanced epidemiological analysis will be used to model influenza trends over time. Integrating virological and epidemiological surveillance data with advanced analysis and timely communication can enhance local preparedness for public health emergencies. Good quality surveillance data will facilitate an understanding outbreak severity and disease seasonality. Real-time data will help provide early warning signals for prevention and control of influenza and COVID-19 outbreaks. The implementation strategies found to be effective in this project can be scaled up to other parts of the country for replication and integration.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India.

The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Towards implementation of context-specific integrated district mental healthcare plans: A situation analysis of mental health services in five districts in Ghana.

Access to quality mental health services in Ghana remains poor, yet little is known about the extent of the access gaps and provision of mental health services at the district level in Ghana. We aimed to conduct an analysis of mental health infrastructure and service provision in five districts in Ghana. A cross-sectional situation analysis was conducted using a standardised tool to collect secondary healthcare data, supplemented by interviews with key informants, across five purposively selected districts in Ghana. The Programme for Improving Mental Health Care (PRIME) situation analysis tool was adapted to the Ghanaian context and used for data collection. The districts are predominantly rural (>60%). There were severe challenges with the provision of mental healthcare: there were no mental healthcare plans, supervision of the few mental health professionals was weak and unstructured, access to regular supplies of psychotropic medications was a major challenge, and psychological treatments were extremely limited given the lack of trained clinical psychologists. There were no available data on treatment coverage, but we estimate this to be <1% for depression, schizophrenia, and epilepsy across districts. Opportunities for mental health systems strengthening include: the commitment and willingness of leadership, the existence of the District Health Information Management System, a well-established network of community volunteers, and some collaboration with traditional and faith-based mental health service providers. There is poor mental health infrastructure across the five selected districts of Ghana. There are opportunities for strengthening mental health systems through interventions at the district healthcare organisation, health facility, and community levels. A standardised situation analysis tool is useful for informing district-level mental healthcare planning in low-resource settings in Ghana and potentially other sub-Saharan African countries.

Computer Games vs Law: Virtualization and Transformation of Political and Legal Institutions

The paper provides an analysis of virtual reality as a subject of regulation while underlining the similarity of principles in gaming and regulatory activities as the elements of virtual reality. A deeper insight into the relationships between regulatory and gaming activities allows to make a statement that gaming provides a tool for situational analysis to identify the most rational action among the available alternatives thus offering a way to construct a legal reality. Assuming that people will make decisions by weighing costs and benefits to maximize the “utility”, and will interact with others by balancing preferences and constraints, the immersion into the gaming environment and observation of the process of rational decision-making will allow to construct predictive and explanatory models for pubic authorities to organize a relatively efficient law-making process. Moreover, the reciprocal influence of the gaming and legal environment has been persistently ignored by the law enforcement practices, only to result in legal gaps. A careful and comprehensive study of gaming as a legal phenomenon is thus a prerequisite of balanced and adequate lawmaking as well as enforcement. Therefore, this study purports to examine the points of contact between the gaming and the legal reality, and assess the existing legal gaps and prospects of creating and eventually applying “virtual” law. The methodology of the study includes general philosophic and scholar methods (analysis, synthesis, logical and systemic methods), specific research and legal methods (including formal legal analysis). The authors propose to make a definition of virtual law and to identify the levels of virtual environment. In analyzing the virtual environment, the authors conclude that it needs to be viewed through the lens of legal regulation since the virtual nature of computer games gives rise to socially important and potentially controversial interactions between players, platforms and developers that need to be mediated. The authors finally conclude that superficial and skeptical attitude of jurisprudence towards the gaming industry is unacceptable while regulatory problems have to be addressed both in science and law. Internationally, the legal systems are already developing a set of provisions — virtual law, Internet law — designed to regulate socially important aspects of computer games

Health and care system assessment aimed at cultural adaptation of MhGAP modules

IntroductionAs part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.ObjectivesAs part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.MethodsThe methodology used was mixed.A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.ResultsThe data collected from 9 health centers in the two provinces allowed us to learn about:- Poor knowledge of mental health and school readiness- Identification of barriers to access to care- Beliefs around mental health, mental suffering and care- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.ConclusionsThe evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.Disclosure of InterestNone Declared

Medical officers as the key stakeholders in district level hospitals in Kenya

Background: A core component of the World Health Organization (WHO) infection prevention and control (IPC) recommends that staffing levels be adequate for the patient workload. The lack of health-care workers in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa is well documented; one way to alleviate the burden of surgical infections without a large commitment of resources is to better train and educate existing facility staff. The study aimed to understand the current allocation of the surgical workload in district level hospitals in Kenya to create targeted task-shifting and education programs. Methods: We developed a cross-sectional survey on IPC practices, adapted from the WHO Guideline on Core Components for IPC and the WHO Emergency and Essential Surgical Care Situational Analysis Tool, for use in district level facilities in LMICs. The survey components included IPC guidelines, surveillance, workload and environment, hospital characteristics, clinical workforce, obstetrical outcomes, and perioperative care practices. In a pilot feasibility trial of the survey tool, data were collected from 27 district level hospitals in Kenya from March to May 2019. These facilities were selected in part based on their capacity to provide comprehensive maternal and obstetric care, including cesarean operations, as cesareans make up the majority of surgeries in the regions and are associated with high surgical site infection rates. Results: The facilities included in the survey pilot serve an estimated population of 3,615,166. The average number of annual admissions was 7801 (Range: 1190–25,783). Thirteen of the 27 total facilities (48.1%) had no certified surgeons, six facilities had one certified surgeon (22.2%), and eight facilities employed two or more certified surgeons. In contrast, almost all facilities (n = 25; range: 2–15) employed medical officers who performed cesarean operations. The number of nurses in surgical and obstetricians and gynecologists wards ranged from 4 to 101, with an average of 27 years. Conclusion: Dedicating specialized training and education to medical officers and engaging them as key stakeholders is the key to creating practical and sustainable change when it comes to safe surgical provision of surgical and obstetric care within Kenya.

Adapting infection prevention and control assessment tools for use in low- and middle-income countries

Background: There are many existing infection prevention and control (IPC) tools developed and validated by large organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention. These tools are generally created with little input from professionals working in low-income regions and are tested in high-income countries and/or high-level facilities in low- and middle-income countries (LMICs). Recent publications have highlighted both the disproportionate burden of surgical site infections (SSIs) in LMICs and the very limited data on surgical conditions and practices in these regions. There is a need and a desire for quality improvement in SSI/IPC/patient safety in low-level facilities in LMIC. Therefore, a logical starting point would be to adapt available tools for use in resource-limited facilities, with a strong focus on input and enthusiastic participation from local health-care workers and leadership. Our goal was to assess IPC capacity of facilities by analyzing health-care-associated infection (HAI) surveillance, hospital workforce and infrastructure, environmental cleaning, and surgical operative practices. Methods: We created an adapted survey using components from the WHO’s Guideline on Core Components for IPC and Essential Surgical Care Situational Analysis Tool that addressed IPC program support, HAI surveillance, surgical preparation practices, and infrastructural support. Purposive sampling was used to identify 23 health facilities across 7 counties in Kenya. We chose to use cesarean section as a bellwether procedure because it is a high-volume procedure in LMIC. Permission to conduct the survey was solicited from facility leadership prior to the beginning of the survey. Two surveyors visited each facility to complete the adapted assessment framework. Results: All facilities had an IPC program and 22 (95.6%) reported that their program was supported by facility leadership and a professional IPC team. However, only 10 (43.5%) facilities reported a specific IPC budget. Eight (34.8%) facilities had on-site and 8 (34.8%) had off-site microbiological laboratory. Twelve (52.2%) conducted HAI surveillance, and out of those that conducted HAI surveillance, 11 (91.7%) monitored specifically for SSIs. Most had adequate and reliable water (95.6%) and power (91.3%). Fifteen (65.2%) allowed bed-sharing and 6 (26.1%) placed beds in hallways or areas other than rooms. Over 75% of facilities did not follow the WHO-recommended preoperative practices on bathing, hair removal, and skin preparation. Conclusions: This survey was a time and resource-efficient way of collecting the data needed to understand the variables associated with surgery, SSI, and IPC in low-level facilities. Clear targets for surgical practice improvement were identified, and the workforce and infrastructure data will be used to design effective and sustainable solutions.

Surgical care and trauma patients capacity in Piura, Perú - Cross-sectional study.

Low and medium income countries face challenges in access and delivery of surgical care, resulting in a high number of deaths and disabled individuals. To estimate the capacity to provide surgical and trauma care in public hospitals in the Piura region, Perú, a middle income country. A survey was administered in public hospitals in the Peruvian region of Piura, which combined the Spanish versions of the PIPES and INTACT surveys, and the WHO situational analysis tool. The extent of the event was assessed based in the absolute differences between the medians of the scores estimated, and the Mann-Whitney bilateral tests, according to the geographical location and the level of hospital complexity. Seven public hospitals that perform surgeries in the Piura region were assessed. Three provinces (3/8) did not have any complexity healthcare institutions. The average hospital in the peripheral provinces tended to be smaller than in the capital province in INTACT (8.25 vs. 9.5, p = 0.04). Additionally, water supply issues were identified (2/7), lack of incinerator (3/7), lack of uninterrupted availability of a CT-scanner (5/7) and problems with working hours; in other words, the blood banks in two hospitals were not open 24 hours. There is a significant inequality among the provinces in the region in terms of their trauma care capacities and several shortfalls in the public sector healthcare infrastructure. This information is required to conduct future research on capacity measurements in every public and private institution in the Peruvian region of Piura.

Eye health for all in Aotearoa New Zealand: summarising our situation using a WHO tool

On 27 July 2022, Aotearoa New Zealand became the first high-income country to launch a report of its eyecare situation using the Eye Care Situation Analysis Tool (ECSAT) recently revised by the World Health Organization (WHO).1 This launch sees Aotearoa join other countries from the Western Pacific region that have long been leaders in efforts to improve eye health nationally and globally. Examples include Australia, Singapore, Tonga and China that led or co-sponsored initiatives that saw resolutions on eye health adopted by the World Health Assembly (WHA73.4, 2020) and the United Nations Resolution on Vision (A/RES/75/310).

The impact of novel coronavirus disease (COVID-19) on emergency and essential surgical care in Gedeo and Sidama zone hospitals: An institutional-based multicenter cross-sectional study

BackgroundCOVID-19 was initially detected in China's Wuhan, the capital of Hubei Province, in December 2019, and has since spread throughout the world, including Ethiopia. Long-term epidemics will overwhelm the capacity of hospitals and the health system as a whole, with dire consequences for the developing world's damaged health systems. Focusing on COVID-19-related activities while continuing to provide essential services such as emergency and essential surgical care is critical not only to maintaining public trust in the health system but also to reducing morbidity and mortality from other illnesses. The goal of this study was to see how COVID-19 affected essential and emergency surgical care in Gedeo and Sidama zone hospitals. Methodology: A cross-sectional study was carried out in ten (10) hospitals in the Gedeo and Sidama zone. The information was gathered with the help of the world health organization (WHO) situational analysis tool for determining emergency and essential surgical care (EESC) capability. Infrastructure, human resources, interventions, and EESC equipment and supplies were used to assess the hospitals' capacity. Result54.3% of the 35 fundamental therapies indicated in the instrument were available before COVID-19 at all sites, while 25.2 percent were available after the COVID-19 pandemic. During the COVID-19 pandemic, there was a sharing of resources for treatment centers, such as a scarcity of oxygen and anesthesia machines, and emergency surgery was postponed. Before admission, the average distance traveled was 58 km. ConclusionThe COVID-19 pandemic, as well as existing disparities in infrastructure, human resources, service provision, and essential equipment and supplies, reveal significant gaps in hospitals' capacity to provide emergency and essential surgical services and effectively address the growing surgical burden of disease and injury in Gedeo and Sidama zone primary, general, and referral hospitals.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

IntroductionMental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as ‘early-adopter’ countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative.MethodsWe used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health.ResultsEach country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment.ConclusionsThis rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Surgical Capacity in Rural Southeast Nigeria: Barriers and New Opportunities.

Background:Remarkable gains have been made in global health with respect to provision of essential and emergency surgical and anesthesia care. At the same time, little has been written about the state of surgical care, or the potential strategies for scale-up of surgical services in sub-Saharan Africa, southeast Nigeria inclusive.Objective:The aim was to document the state of surgical care at district hospitals in southeast Nigeria.Methods:We surveyed 13 district hospitals using the World Health Organization (WHO) tool for situational analysis developed by the “Lancet Commission on Global Surgery” initiative to assess surgical care in rural Southeast Nigeria. A systematic literature review of scientific literatures and policy documents was performed. Extraction was performed for all articles relating to the five National Surgical, Obstetric and Anesthesia Plans (NSOAPs) domains: infrastructure, service delivery, workforce, information management and financing.Findings:Of the 13 facilities investigated, there were six private, four mission and three public hospitals. Though all the facilities were connected to the national power grid, all equally suffered electricity interruption ranging from 10–22 hours daily. Only 15.4% and 38.5% of the 13 hospitals had running water and blood bank services, respectively. Only two general surgeon and two orthopedic surgeons covered all the facilities. Though most of the general surgical procedures were performed in private and mission hospitals, the majority of the public hospitals had limited ability to do the same. Orthopedic procedures were practically non-existent in public hospitals. None of the facilities offered inhalational anesthetic technique. There was no designated record unit in 53.8% of facilities and 69.2% had no trained health record officer.Conclusion:Important deficits were observed in infrastructure, service delivery, workforce and information management. There were indirect indices of gross inadequacies in financing as well.

Learning and Expertise in Mineral Exploration Decision-Making: An Ecological Dynamics Perspective.

The declining discovery rate of world-class ore deposits represents a significant obstacle to future global metal supply. To counter this trend, there is a requirement for mineral exploration to be conducted in increasingly challenging, uncertain, and remote environments. Faced with such increases in task and environmental complexity, an important concern in exploratory activities are the behavioural challenges of information perception, interpretation and decision-making by geoscientists tasked with discovering the next generation of deposits. Here, we outline the Dynamics model, as a diagnostic tool for situational analysis and a guiding framework for designing working and training environments to maximise exploration performance. The Dynamics model is based on an Ecological Dynamics framework, combining Newell’s Constraints model, Self Determination Theory, and including feedback loops to define an autopoietic system. By implication of the Dynamics model, several areas are highlighted as being important for improving the quality of exploration. These include: (a) provision of needs-supportive working environments that promote appropriate degrees of effort, autonomy, creativity and technical risk-taking; (b) an understanding of the wider motivational context, particularly the influence of tradition, culture and other ‘forms of life’ that constrain behaviour; (c) relevant goal-setting in the design of corporate strategies to direct exploration activities; and (d) development of practical, representative scenario-based training interventions, providing effective learning environments, with digital media and technologies presenting decision-outcome feedback, to assist in the development of expertise in mineral exploration targeting.

An Assessment Tool for Hand Surgical Education Needs and Capacity in Resource-Limited Settings.

Hand surgeons have the potential to substantially decrease the surgical disability burden in the developing world through educator trips. The Lancet Commission supports contextually driven educator trips grounded in the needs of local hosts, yet few organizations perform a comprehensive assessment of learning interests or the hosting institutions' surgical capacity before the trips. The authors adapted the Personnel, Infrastructure, Procedures, Equipment, and Supplies questionnaire, which was modified from the World Health Organization's validated Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. The authors revised each aspect of the questionnaire to reflect items pertinent to upper extremity surgery and hand trauma care. They added sections to gauge self-identified learning needs, local disease burden, operative resources, and current practices. The tool was distributed by means of Qualtrics; descriptive statistics were used to summarize data. The authors analyzed the data for all participants and performed two subgroup analyses to examine variation by regions and countries. The authors received 338 responses from 27 countries. There was wide variability in local surgical disease burden, learning interests, and skill level of upper extremity procedures. Although learners were most interested in learning tendon transfers and microsurgical techniques, the majority did not have adequate infrastructure at their institution to sustain capacity for microvascular procedures. Needs assessments can gauge how best to provide education during short-term visiting educator trips and optimize its impact in resource-limited settings. Understanding the needs, learning interests, and availability of resources of local learners is imperative to creating a sustainable global surgical workforce.

District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey.

The role of the district hospital (DH) in surgical care has been undervalued. However, decentralised surgical services at DHs have been identified as a key component of universal health coverage. Surgical capacity at DHs in Western Cape (WC) Province, South Africa, has not been described. To describe DH surgical capacity in WC and identify barriers to scaling up surgical capacity at these facilities. This was a cross-sectional survey of 33 DHs using the World Health Organization surgical situational analysis tool administered to hospital staff from June to December 2019. The survey addressed the following domains: general services and financing; service delivery and surgical volume; surgical workforce; hospital and operating theatre (OT) infrastructure, equipment and medication; and barriers to scaling up surgical care. Seven of 33 DHs (21%) did not have a functional OT. Of the 28 World Bank DH procedures, small WC DHs performed up to 22(79%) and medium/large DHs up to 26 (93%). Only medium/large DHs performed all three bellwether procedures. Five DHs (15%) had a full-time surgeon, anaesthetist or obstetrician (SAO). Of DHs without any SAO specialists, 14 (50%) had family physicians (FPs). These DHs performed more operative procedures than those without FPs (p=0.005). Lack of finances dedicated for surgical care and lack of surgical providers were the most reported barriers to providing and expanding surgical services. WC DH surgical capacity varied by hospital size. However, FPs could play an essential role in surgery at DHs with appropriate training, oversight and support from SAO specialists.Strategies to scale up surgical capacity include dedicated financial and human resources.

The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions.

Background:Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs.Methods:A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the “World Health Organization Situation Analysis tool” database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV.Results:A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV.Conclusion and Global Health Implications:We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally.