Slow Progress In Implementation Research Articles

Smokeless tobacco policy in Bangladesh: A stakeholder study of compatibility with the World Health Organization's Framework Convention on Tobacco Control.

Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC. We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis. Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources. Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.

Disease Interpretations and Response among HIV-positive Mothers

Despite the growing number of new cases of HIV and AIDS in Indonesia, the progress of prevention programs has been slow. Low prevalence is always stated as a reason for delaying HIV prevention programs and to justify slow progress in implementation. Prevention programs are moreover based on a high-risk group paradigm. They focus on female sex workers as responsible for the spread of HIV, leading to its stigmatization as a hooker’s disease. This article describes how seropositive mothers interpret and respond to HIV and AIDS as women, in light of the fact that most of them have not experienced full-blown AIDS. Some women had already experienced severe illnesses caused by HIV but defined their ill health by the symptoms they experienced, revealing that they did not really feel as if they were living with HIV and AIDS. Despite the fact that some members had died due to AIDS, many still could not believe that they were suffering from HIV and AIDS or that their illnesses were caused by it; rather, their symptoms were of other diseases such as diarrhoea, tuberculosis, or hepatitis. And though they realized that their past (or present) behaviours put them at risk, they maintained that they were victims who had contracted the disease from their promiscuous or drug-injecting husbands. Even when they did admit that their own behaviour had something to do with it, they did not consider HIV and AIDS as a disease but a curse from God, a punishment for their immoral behaviour. Keywords: Women, Infectious Disease, Interpretation, HIV and AIDS, Support Group, Indonesia

Challenges regarding the implementation of the basic antenatal care approach in eThekwini District, Kwazulu-Natal.

The aim of the study was to investigate the challenges experienced by midwives during the implementation of the Basic Antenatal Care programme. The National Department of Health recommended that all primary health care facilities in South Africa start to implement the Basic Antenatal Care programme by the end of 2008. In her work as coordinator of the Maternal Child and Women's Health programme for the eThekwini Municipality, the researcher observed the slow progress in implementation of the programme in the eThekwini district. A descriptive qualitative design using questionnaires was used to assess the challenges being experienced by midwives during the implementation of the programme. The challenges identified included: shortage of staff, lack of cooperation from referral hospitals, lack of in-service training, problems with transportation of specimens to laboratories, lack of material resources, unavailability of Basic Antenatal Care programme guidelines and lack of management support. The challenges were the possible cause of the slow progress in the implementation of the programme. The successful implementation of the new programme is dependent on support and guidance offered by the nurse manager to the staff at operational level. The manager should monitor and develop strategies to address and overcome challenges that hinder implementation of the Basic Antenatal Care programme.

The Millennium Development Goals: the pledge of world leaders to end poverty will not be met with business as usual

AbstractThis article reviews the prospects for achieving the Millennium Development Goals. It argues that these goals will not be achieved by the target date of 2015 unless new action is taken by both rich and poor countries. It shows that current trends sharply contrast countries on their way to meeting the goals and those in a poverty trap. Crisis proportions have been reached in deterioration of life expectancy and falling incomes, but also in a wide range of other indicators in countries such as Zambia as well as Nepal. The origins of this crisis are not just poor governance or poor macroeconomic policies, but rather the difficulties of competing in global markets. A priority for these countries is to invest in basic education and health, infrastructure, agriculture and manufacturing. Rich countries have fallen seriously behind in living up to their promises to increase aid, debt relief and access to their markets for exports from developing countries—with the welcome but still inadequate increase in aid to reach the 0.7 per cent GDP target, with the collapse of trade talks at Cancun, slow implementation of HIPC, and slow progress in implementation of TRIPS provision for access to technology. Business as usual will not be enough to meet the goals and new action is urgently needed to achieve the goals. Copyright © 2004 John Wiley & Sons, Ltd.