This document discusses lessons for sustainability that can be drawn from the Uganda Rural Water and
Sanitation (RUWASA) project, which was implemented from 1991-2001 in eastern Uganda. The key findings
are:
1. Latrine coverage and access to safe water increased substantially in the districts of Pallisa and Kamuli even
after the RUWASA project ended, showing its sustained impact.
2. Factors that contributed to the project's sustainability included community involvement in planning and
maintenance, community contributions towards infrastructure, and training local mechanics to conduct repairs.
3. Close involvement of communities helped build trust and secure ongoing financial and labor contributions,
fostering a sense of ownership over the water sources and
This document presents a cost-benefit analysis framework for evaluating India's Total Sanitation Campaign which aims to provide rural sanitation through individual household latrines and community latrines. It outlines the various stakeholders involved, costs associated with construction, information campaigns and maintenance, and potential health and economic benefits of reduced diarrhea incidence. While benefits include healthcare savings, increased productivity, and time savings, there are challenges in accurately quantifying reductions in disease and assigning monetary values to intangible benefits. The framework is intended to help assess the balanced approach between individual and community latrines and provide evidence of the financial benefits of the sanitation program.
The Healthy Neighbors program at Yale School of Nursing aims to improve the health and lives of residents at the Church Street South apartments, a subsidized housing project near the school. The program began with annual health fairs but has expanded to include daily tutoring sessions for younger residents during the school year. Fifteen YSN students now provide tutoring and help coordinate twice-annual health education fairs. The goal is for YSN students to build relationships and gain a deeper understanding of the community's health needs.
The nursing profession faces several challenges in the 21st century including a growing elderly population that requires more acute care, rising healthcare costs, and the need to adapt to rapid advances in medical technology. There is also a shortage of nurses exacerbated by an aging workforce and many nurses leaving their jobs to work abroad. Nurse managers play an important role in creating work environments that support nurses, improve patient outcomes, and help address these challenges facing the nursing profession.
This document summarizes Edward Gilman's scholarly project on public health informatics. It defines public health informatics as the systematic application of information and computer science to public health practice, research, and learning. It reviews the history of public health informatics, challenges and solutions to public health, the partnership between primary care and public health, and global public health surveillance. The conclusion states that data and information are critical to public health operations but many health departments lack informatics capabilities and need financial support to improve practices and population health outcomes.
Managing sustainability and resilience in the sri lankan copy (2)Ranga Sabhapathige
The Sri Lankan health system has achieved high life expectancy and low mortality rates. It is financed through government funding and provides largely free healthcare. However, maintaining long-term sustainability depends on affordability, acceptability, and adaptability. Affordability relies on reasonable budget allocations despite declining expenditures. Acceptability involves effective governance, regulations, and engaging stakeholders. Adaptability allows withstanding challenges through organized service delivery and resilient responses during crises like tsunamis.
Field Building Leadership Initiative (FBLI): Advancing ecohealth in Southeast...ILRI
Presentation by Hung Nguyen-Viet, Wiku Adisasmito, Pattamaporn Kittayapong, Fang Jing, Xuan Tung Dinh and Phuc Pham Duc at the 4th International One Health Congress and 6th Biennial Congress of the International Association for Ecology and Health (One Health EcoHealth 2016), Melbourne, Australia, 3–7 December 2016.
A GUIDE TO SDG INTERACTIONS: FROM SCIENCE TO IMPLEMENTATIONAntonio Arcadu
This document provides an analysis of interactions between the 17 UN Sustainable Development Goals (SDGs). It assesses interactions between SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 7 (affordable and clean energy), and SDG 14 (life below water) and the other goals. A total of 316 target-level interactions were identified, with most being positive or reinforcing relationships. Key findings include that progress in areas like clean energy and sustainable agriculture can simultaneously support goals around health, food security, and environmental protection. The analysis aims to support integrated policymaking and identify areas where coordinated action across sectors and goals is needed to realize synergies and manage trade-offs between the
The COVID-19 pandemic has severely impacted families in Sri Lanka that World Vision supports. A survey of over 2,000 families found:
- 88% experienced a drop in income and 42% lost their jobs due to lockdowns. Many resorted to borrowing or reducing meals.
- 73% had only a week's supply of food and essential items were in short supply. Many children and adults skipped meals.
- Livelihoods were disrupted and children's education and access to services were affected. Parents struggled with childcare.
- The response should focus on livelihood recovery, food security, education support, and child protection over the next six months. Unconditional cash grants, home gardening, and distance learning
This document presents a cost-benefit analysis framework for evaluating India's Total Sanitation Campaign which aims to provide rural sanitation through individual household latrines and community latrines. It outlines the various stakeholders involved, costs associated with construction, information campaigns and maintenance, and potential health and economic benefits of reduced diarrhea incidence. While benefits include healthcare savings, increased productivity, and time savings, there are challenges in accurately quantifying reductions in disease and assigning monetary values to intangible benefits. The framework is intended to help assess the balanced approach between individual and community latrines and provide evidence of the financial benefits of the sanitation program.
The Healthy Neighbors program at Yale School of Nursing aims to improve the health and lives of residents at the Church Street South apartments, a subsidized housing project near the school. The program began with annual health fairs but has expanded to include daily tutoring sessions for younger residents during the school year. Fifteen YSN students now provide tutoring and help coordinate twice-annual health education fairs. The goal is for YSN students to build relationships and gain a deeper understanding of the community's health needs.
The nursing profession faces several challenges in the 21st century including a growing elderly population that requires more acute care, rising healthcare costs, and the need to adapt to rapid advances in medical technology. There is also a shortage of nurses exacerbated by an aging workforce and many nurses leaving their jobs to work abroad. Nurse managers play an important role in creating work environments that support nurses, improve patient outcomes, and help address these challenges facing the nursing profession.
This document summarizes Edward Gilman's scholarly project on public health informatics. It defines public health informatics as the systematic application of information and computer science to public health practice, research, and learning. It reviews the history of public health informatics, challenges and solutions to public health, the partnership between primary care and public health, and global public health surveillance. The conclusion states that data and information are critical to public health operations but many health departments lack informatics capabilities and need financial support to improve practices and population health outcomes.
Managing sustainability and resilience in the sri lankan copy (2)Ranga Sabhapathige
The Sri Lankan health system has achieved high life expectancy and low mortality rates. It is financed through government funding and provides largely free healthcare. However, maintaining long-term sustainability depends on affordability, acceptability, and adaptability. Affordability relies on reasonable budget allocations despite declining expenditures. Acceptability involves effective governance, regulations, and engaging stakeholders. Adaptability allows withstanding challenges through organized service delivery and resilient responses during crises like tsunamis.
Field Building Leadership Initiative (FBLI): Advancing ecohealth in Southeast...ILRI
Presentation by Hung Nguyen-Viet, Wiku Adisasmito, Pattamaporn Kittayapong, Fang Jing, Xuan Tung Dinh and Phuc Pham Duc at the 4th International One Health Congress and 6th Biennial Congress of the International Association for Ecology and Health (One Health EcoHealth 2016), Melbourne, Australia, 3–7 December 2016.
A GUIDE TO SDG INTERACTIONS: FROM SCIENCE TO IMPLEMENTATIONAntonio Arcadu
This document provides an analysis of interactions between the 17 UN Sustainable Development Goals (SDGs). It assesses interactions between SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 7 (affordable and clean energy), and SDG 14 (life below water) and the other goals. A total of 316 target-level interactions were identified, with most being positive or reinforcing relationships. Key findings include that progress in areas like clean energy and sustainable agriculture can simultaneously support goals around health, food security, and environmental protection. The analysis aims to support integrated policymaking and identify areas where coordinated action across sectors and goals is needed to realize synergies and manage trade-offs between the
The COVID-19 pandemic has severely impacted families in Sri Lanka that World Vision supports. A survey of over 2,000 families found:
- 88% experienced a drop in income and 42% lost their jobs due to lockdowns. Many resorted to borrowing or reducing meals.
- 73% had only a week's supply of food and essential items were in short supply. Many children and adults skipped meals.
- Livelihoods were disrupted and children's education and access to services were affected. Parents struggled with childcare.
- The response should focus on livelihood recovery, food security, education support, and child protection over the next six months. Unconditional cash grants, home gardening, and distance learning
The document discusses the rationale for reforming health professions education and systems for health using an ICF framework. It argues this could ultimately result in personalized, predictive healthcare through the use of big data and patient-driven data obtained by utilizing an ICF paradigm. This reform seeks to move towards community-based, holistic care with shared decision-making and reduce institutionalized silos. It is dependent on technology and utilizing the ICF framework could contribute to reaching health equity goals by strengthening systems for universal healthcare coverage.
Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education
Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology
Integrating Digital Healthcare Services for Rural People in Underdeveloped Na...Prf Rajesh
This document discusses integrating digital healthcare services into university curriculum in Nepal. It provides background on Nepal, including its population, healthcare system, and equity gaps in rural access to services. Digital healthcare can help bridge those gaps by providing telemedicine, mobile apps, and remote monitoring. Nepal has developed an e-health strategy and initiatives like Amakomaya to improve maternal health through mobile technology. However, barriers include infrastructure, skills, and acceptance. Universities must play a role by introducing ICT and digital health courses to develop expertise and create public-private partnerships to advance digital healthcare, as seen at Stanford University. Pokhara University is working to include these areas in programs like health engineering and data analytics.
The document discusses provisions of the Affordable Care Act that provide funding to address the primary care provider shortage in the United States. It notes that the ACA invests in expanding the primary care workforce through funding for medical education and support for nurses and nurse practitioners. In particular, it allocates grants and loan repayment programs to nursing schools to boost enrollment and support for students. The document argues this increased funding for primary care training and education is critical to fulfill the goals of the ACA to expand access and improve healthcare outcomes in the face of growing demand for primary care services.
Animal Disease Control Project implementing officers constraints while undert...KVASU
This document discusses constraints faced by veterinary surgeons implementing foot and mouth disease (FMD) control in Kerala. The most relevant constraints included farmers' unwillingness to vaccinate due to reduced milk yield, door-to-door vaccination being laborious, and possible vaccine side effects. Relevant constraints were negative media reports, responsibility for post-vaccination issues, and farmers' negative attitudes toward vaccination. Less relevant constraints included farmers' reluctance based on experience, education and herd size. The document provides policy and strategy recommendations to address these constraints.
Socioeconomic differentials in the use of selected reproductive health servic...Golam Kibria Madhurza
This document summarizes a study examining socioeconomic differentials in the use of reproductive health services in Bangladesh. The study finds that public sector services remain the primary source of modern contraceptives for rural, less educated, and poor women. Wealthier individuals and those in urban areas are more likely to use private services for antenatal care and delivery. A multivariate analysis shows socioeconomic status significantly impacts the likelihood of choosing different service providers. While NGO expansion has increased access, socioeconomic status does not influence choice of NGO services. The study concludes more attention is needed on reproductive health determinants to reduce maternal mortality.
This summary describes a quasi-experimental study with a one-group pretest-posttest design that evaluated the effectiveness of an educational intervention on dietary guidelines for adults in Newton County, Mississippi. A convenience sample of 50 community-dwelling adults between 18-64 years old participated. Data was collected using the Health Behavior Survey before and after the intervention, which took place in a classroom and consisted of lectures and discussions. The study aimed to determine if the intervention increased awareness of a healthy, balanced diet and decreased risk for chronic disease, but only found a significant effect for some dietary behaviors and not others like physical activity levels.
This literature review examines concepts of quality of life for residents in nursing home facilities. It discusses person-centered care which prioritizes resident autonomy, dignity and choice. Culture change aims to shift care from a medical model to a person-centered model through staff education, meaningful activities and consistent staffing. Relationships between residents and family, friends, staff and other residents impact well-being. Daily uplifts and story sharing can help staff build relationships. Resident choice in activities and spirituality can enhance satisfaction. The Selective Optimization with Compensation model describes how older adults adapt to loss of function through selection, optimization and compensation. Overall the literature emphasizes improving quality of life through individualized, enriched care plans.
The document outlines several key challenges facing Sri Lanka's health system, including an increasing burden of non-communicable diseases due to an aging population and epidemiological transition. Emerging infectious diseases like dengue and COVID-19 also present challenges. Funding shortages constrain health sector development as most funds are spent on recurring costs rather than capital projects. There are issues with uneven distribution of healthcare workers, lack of continuous training programs, and overcrowding of secondary and tertiary hospitals due to direct access without proper referrals. Trade union interventions also pose problems for health sector reforms.
Example of a leaflet designed for ResultsinHealthSuzan Maliepaard
1) The document reports on a study that used the Most Significant Change technique to understand the impact of losing cash transfers through Indonesia's Family Hope Program (PKH) on graduated households. 2) 45 stories of most significant changes were collected from 6 provinces, which identified changes in economic conditions, human capital, social participation, and dependency on assistance. 3) The majority of most significant changes related to increased awareness of children's education importance, employment, motivation to work, and financial situations as families sought to keep children in school.
This paper presents analysis of a Kent ‘whole population’ dataset, linking wholepopulation demographics with activity and cost data for the population from acute, community, mental health and social care providers. The data helps commissioners to understand the impact of different selections methods for people with ‘very complex’ health and social care needs, particularly in relation to the development of a LTC year of care currency.
This document should be seen alongside the ‘Recovery, Rehabilitation and Reablement – step-by-step guide’ which describes how providers can carry out the audit in their own organisation. Other documents and learning materials This document is part of a suite of learning materials being produced by the LTC Year of Care Commissioning Programme to support the spread and adoption of capitated budgets for people with complex care needs.
This document outlines the process and goals of a regional health care safety net summit. It provides background on the initiative, including key terminology, assumptions, and demographic data of the region. It also summarizes ongoing efforts to strengthen the safety net and the Chicago Metropolitan Agency for Planning's GoTo 2040 plan, which includes recommendations to integrate health policy into regional planning. The document introduces preliminary recommendations that will be discussed at the summit to continue progressing the initiative.
This document discusses the role of information technology in public health. It describes how public health encompasses efforts to promote health and prevent disease through determinants of health, healthcare systems, and public policy. It explains that databases, surveillance systems, and other tools are used to collect and analyze health data, facilitating epidemiology, maternal/child health, environmental health, and more. The document also lists several information technologies like teleconferencing, web boards, and videoconferencing that can support public health activities.
This document discusses health literacy and its relevance for Health Promoting Hospitals. It provides an overview and discusses three key points: 1) Why health literacy is relevant for Health Promoting Hospitals, 2) What health literacy is about in more detail, and 3) How health literacy can be implemented in Health Promoting Hospitals. Low health literacy is linked to poorer health outcomes and higher healthcare costs. Studies show people with low health literacy have more emergency visits, hospital admissions, and worse management of chronic conditions. Improving health literacy can strengthen the effectiveness and efficiency of healthcare systems. The document discusses measures of health literacy and associations between health literacy and health behaviors and outcomes.
This document summarizes several funded projects from the Pathways to Health Equity for Aboriginal Peoples initiative. It describes 3 projects that received funding: 1) to study the implementation and cultural adaptation of a mental health promotion program for First Nations communities, 2) to develop a vision for culturally relevant housing from the perspectives of two Dene First Nations in Manitoba, and 3) to inform a tuberculosis strategy for First Nations communities by using data from a previous study on TB transmission in prairie provinces. It also provides information on additional funding opportunities through Applied Public Health Chairs and Partners for Engagement and Knowledge Exchange to support Aboriginal health research.
Integrating Health Care Communities of Practice - Uruguay Final Cme New Integ...Ann Séror
This document discusses the integration of health care communities of practice in Uruguay. It provides background on Uruguay's national health care system and knowledge management strategies. It then analyzes Uruguay's health care knowledge ecology, including national institutions, regional virtual infrastructures like BIREME and SciELO Uruguay, and emerging collaborative spaces between communities of practice. Future research opportunities are identified in institutional roles, physician roles, and research methodology within Uruguay's dynamic knowledge ecology.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
This document discusses medical nutrition therapy (MNT), which is the application of nutrition assessment, intervention, and counseling to manage disease and improve health outcomes. MNT is provided by registered dietitian nutritionists and involves a standardized process called the nutrition care process. This includes nutrition assessment, diagnosis, intervention, and monitoring. The nutrition assessment involves collecting information on diet, anthropometrics, labs, physical findings, and medical history. This information is used to determine a nutrition diagnosis and develop an individualized nutrition intervention plan to address any identified dietary contributors to disease. MNT has been shown to improve clinical outcomes and lower healthcare costs for many chronic conditions.
Countrywide Tech has a computer support experts have been the premiere source of affordable Microsoft Windows network integration and Countrywide Tech providing IT consulting services for businesses Whether your small business needs a tech support expert, IT consultant, or systems engineer
Este documento describe los sistemas sensorial y locomotor del cuerpo humano. Explica los receptores sensoriales, los sentidos como el olfato, el gusto, el tacto, la audición y la visión. También describe el sistema esquelético formado por huesos y articulaciones, y el sistema muscular que permite el movimiento. Por último, menciona dos enfermedades comunes del aparato locomotor: la artrosis que causa degeneración del cartílago, y la artritis que provoca inflamación de las articulaciones.
The document discusses the rationale for reforming health professions education and systems for health using an ICF framework. It argues this could ultimately result in personalized, predictive healthcare through the use of big data and patient-driven data obtained by utilizing an ICF paradigm. This reform seeks to move towards community-based, holistic care with shared decision-making and reduce institutionalized silos. It is dependent on technology and utilizing the ICF framework could contribute to reaching health equity goals by strengthening systems for universal healthcare coverage.
Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education
Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology
Integrating Digital Healthcare Services for Rural People in Underdeveloped Na...Prf Rajesh
This document discusses integrating digital healthcare services into university curriculum in Nepal. It provides background on Nepal, including its population, healthcare system, and equity gaps in rural access to services. Digital healthcare can help bridge those gaps by providing telemedicine, mobile apps, and remote monitoring. Nepal has developed an e-health strategy and initiatives like Amakomaya to improve maternal health through mobile technology. However, barriers include infrastructure, skills, and acceptance. Universities must play a role by introducing ICT and digital health courses to develop expertise and create public-private partnerships to advance digital healthcare, as seen at Stanford University. Pokhara University is working to include these areas in programs like health engineering and data analytics.
The document discusses provisions of the Affordable Care Act that provide funding to address the primary care provider shortage in the United States. It notes that the ACA invests in expanding the primary care workforce through funding for medical education and support for nurses and nurse practitioners. In particular, it allocates grants and loan repayment programs to nursing schools to boost enrollment and support for students. The document argues this increased funding for primary care training and education is critical to fulfill the goals of the ACA to expand access and improve healthcare outcomes in the face of growing demand for primary care services.
Animal Disease Control Project implementing officers constraints while undert...KVASU
This document discusses constraints faced by veterinary surgeons implementing foot and mouth disease (FMD) control in Kerala. The most relevant constraints included farmers' unwillingness to vaccinate due to reduced milk yield, door-to-door vaccination being laborious, and possible vaccine side effects. Relevant constraints were negative media reports, responsibility for post-vaccination issues, and farmers' negative attitudes toward vaccination. Less relevant constraints included farmers' reluctance based on experience, education and herd size. The document provides policy and strategy recommendations to address these constraints.
Socioeconomic differentials in the use of selected reproductive health servic...Golam Kibria Madhurza
This document summarizes a study examining socioeconomic differentials in the use of reproductive health services in Bangladesh. The study finds that public sector services remain the primary source of modern contraceptives for rural, less educated, and poor women. Wealthier individuals and those in urban areas are more likely to use private services for antenatal care and delivery. A multivariate analysis shows socioeconomic status significantly impacts the likelihood of choosing different service providers. While NGO expansion has increased access, socioeconomic status does not influence choice of NGO services. The study concludes more attention is needed on reproductive health determinants to reduce maternal mortality.
This summary describes a quasi-experimental study with a one-group pretest-posttest design that evaluated the effectiveness of an educational intervention on dietary guidelines for adults in Newton County, Mississippi. A convenience sample of 50 community-dwelling adults between 18-64 years old participated. Data was collected using the Health Behavior Survey before and after the intervention, which took place in a classroom and consisted of lectures and discussions. The study aimed to determine if the intervention increased awareness of a healthy, balanced diet and decreased risk for chronic disease, but only found a significant effect for some dietary behaviors and not others like physical activity levels.
This literature review examines concepts of quality of life for residents in nursing home facilities. It discusses person-centered care which prioritizes resident autonomy, dignity and choice. Culture change aims to shift care from a medical model to a person-centered model through staff education, meaningful activities and consistent staffing. Relationships between residents and family, friends, staff and other residents impact well-being. Daily uplifts and story sharing can help staff build relationships. Resident choice in activities and spirituality can enhance satisfaction. The Selective Optimization with Compensation model describes how older adults adapt to loss of function through selection, optimization and compensation. Overall the literature emphasizes improving quality of life through individualized, enriched care plans.
The document outlines several key challenges facing Sri Lanka's health system, including an increasing burden of non-communicable diseases due to an aging population and epidemiological transition. Emerging infectious diseases like dengue and COVID-19 also present challenges. Funding shortages constrain health sector development as most funds are spent on recurring costs rather than capital projects. There are issues with uneven distribution of healthcare workers, lack of continuous training programs, and overcrowding of secondary and tertiary hospitals due to direct access without proper referrals. Trade union interventions also pose problems for health sector reforms.
Example of a leaflet designed for ResultsinHealthSuzan Maliepaard
1) The document reports on a study that used the Most Significant Change technique to understand the impact of losing cash transfers through Indonesia's Family Hope Program (PKH) on graduated households. 2) 45 stories of most significant changes were collected from 6 provinces, which identified changes in economic conditions, human capital, social participation, and dependency on assistance. 3) The majority of most significant changes related to increased awareness of children's education importance, employment, motivation to work, and financial situations as families sought to keep children in school.
This paper presents analysis of a Kent ‘whole population’ dataset, linking wholepopulation demographics with activity and cost data for the population from acute, community, mental health and social care providers. The data helps commissioners to understand the impact of different selections methods for people with ‘very complex’ health and social care needs, particularly in relation to the development of a LTC year of care currency.
This document should be seen alongside the ‘Recovery, Rehabilitation and Reablement – step-by-step guide’ which describes how providers can carry out the audit in their own organisation. Other documents and learning materials This document is part of a suite of learning materials being produced by the LTC Year of Care Commissioning Programme to support the spread and adoption of capitated budgets for people with complex care needs.
This document outlines the process and goals of a regional health care safety net summit. It provides background on the initiative, including key terminology, assumptions, and demographic data of the region. It also summarizes ongoing efforts to strengthen the safety net and the Chicago Metropolitan Agency for Planning's GoTo 2040 plan, which includes recommendations to integrate health policy into regional planning. The document introduces preliminary recommendations that will be discussed at the summit to continue progressing the initiative.
This document discusses the role of information technology in public health. It describes how public health encompasses efforts to promote health and prevent disease through determinants of health, healthcare systems, and public policy. It explains that databases, surveillance systems, and other tools are used to collect and analyze health data, facilitating epidemiology, maternal/child health, environmental health, and more. The document also lists several information technologies like teleconferencing, web boards, and videoconferencing that can support public health activities.
This document discusses health literacy and its relevance for Health Promoting Hospitals. It provides an overview and discusses three key points: 1) Why health literacy is relevant for Health Promoting Hospitals, 2) What health literacy is about in more detail, and 3) How health literacy can be implemented in Health Promoting Hospitals. Low health literacy is linked to poorer health outcomes and higher healthcare costs. Studies show people with low health literacy have more emergency visits, hospital admissions, and worse management of chronic conditions. Improving health literacy can strengthen the effectiveness and efficiency of healthcare systems. The document discusses measures of health literacy and associations between health literacy and health behaviors and outcomes.
This document summarizes several funded projects from the Pathways to Health Equity for Aboriginal Peoples initiative. It describes 3 projects that received funding: 1) to study the implementation and cultural adaptation of a mental health promotion program for First Nations communities, 2) to develop a vision for culturally relevant housing from the perspectives of two Dene First Nations in Manitoba, and 3) to inform a tuberculosis strategy for First Nations communities by using data from a previous study on TB transmission in prairie provinces. It also provides information on additional funding opportunities through Applied Public Health Chairs and Partners for Engagement and Knowledge Exchange to support Aboriginal health research.
Integrating Health Care Communities of Practice - Uruguay Final Cme New Integ...Ann Séror
This document discusses the integration of health care communities of practice in Uruguay. It provides background on Uruguay's national health care system and knowledge management strategies. It then analyzes Uruguay's health care knowledge ecology, including national institutions, regional virtual infrastructures like BIREME and SciELO Uruguay, and emerging collaborative spaces between communities of practice. Future research opportunities are identified in institutional roles, physician roles, and research methodology within Uruguay's dynamic knowledge ecology.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
This document discusses medical nutrition therapy (MNT), which is the application of nutrition assessment, intervention, and counseling to manage disease and improve health outcomes. MNT is provided by registered dietitian nutritionists and involves a standardized process called the nutrition care process. This includes nutrition assessment, diagnosis, intervention, and monitoring. The nutrition assessment involves collecting information on diet, anthropometrics, labs, physical findings, and medical history. This information is used to determine a nutrition diagnosis and develop an individualized nutrition intervention plan to address any identified dietary contributors to disease. MNT has been shown to improve clinical outcomes and lower healthcare costs for many chronic conditions.
Countrywide Tech has a computer support experts have been the premiere source of affordable Microsoft Windows network integration and Countrywide Tech providing IT consulting services for businesses Whether your small business needs a tech support expert, IT consultant, or systems engineer
Este documento describe los sistemas sensorial y locomotor del cuerpo humano. Explica los receptores sensoriales, los sentidos como el olfato, el gusto, el tacto, la audición y la visión. También describe el sistema esquelético formado por huesos y articulaciones, y el sistema muscular que permite el movimiento. Por último, menciona dos enfermedades comunes del aparato locomotor: la artrosis que causa degeneración del cartílago, y la artritis que provoca inflamación de las articulaciones.
Angelica Sustaita is seeking a position and includes her contact information and education background. She has a 3.79 GPA and is expected to graduate from the University of South Florida in December 2017 with a Bachelor's degree in Accounting. Her resume outlines her qualifications including proficiency in Microsoft programs, organization of projects, creation of budgets, and fluency in Spanish.
Excelente Casa Recém Construída no Recanto de PortugalValmir Marques
A empresa de tecnologia anunciou um novo smartphone com câmera aprimorada, maior tela e bateria de longa duração. O dispositivo também possui processador mais rápido e armazenamento expansível. O novo modelo será lançado em outubro por um preço inicial de US$799.
Este documento describe la técnica de injerto de corona en diferentes árboles y arbustos como naranjo, limonero y mandarino. Explica los pasos para realizar el injerto en primavera cortando una rama del patrón e introduciendo una ramita de la variedad a injertar con cortes en bisel. Luego se sella el injerto con mastique y nailon para que cicatrice y se evite la desecación, dejándolo hasta que broten las yemas. También describe brevemente otros tipos de injertos como el ingl
ViaConnexions is a company established in 2003 that specializes in connecting customers with manufacturing solutions for plastic, metal, circuit boards, and cable assemblies. They offer custom and off-the-shelf products, as well as design, prototyping, and supply chain management services. ViaConnexions works with customers from concept to finished product in industries such as aerospace, automotive, industrial, and medical.
The document discusses the concept of dérive, which involves dropping preconceived plans and allowing oneself to be drawn through environments by the attractions of the terrain and encounters found there. A dérive aims to study how environments and encounters affect one's emotions and behavior. It works best in urban settings with 1-3 people drifting without purpose over the course of a day, experiencing chance encounters. Psychogeography is defined as studying these precise impacts of geography on individuals.
This document is a resume for Hazem Mohamed Mohamed Rabie, an Egyptian civil engineer with over 30 years of experience in construction supervision and quality control. It lists his education, professional qualifications, and work experience overseeing various civil engineering projects in Egypt, Yemen, Malawi, and Abu Dhabi, including tunnels, bridges, roads, pumping stations, and more. His roles have included project manager, site manager, contract engineer, and site engineer. He is proficient in Arabic, English, Microsoft Word, Excel, and AutoCAD.
The document analyzes different types of blog posts and their effectiveness. It identifies 10 types of posts: memes, lists, piggybacking, life blogging, detractor posts, breaking news, links, reviews, surveys, and live blogging. For each type, it explains what it is, provides examples, discusses why it works and its difficulty to create and potential to generate attention. The conclusion rates each type based on these criteria to help bloggers determine what kind of posts may work best for their blog.
Enfermedades infecciosas de los elefantesSlider Lecter
Este documento resume las principales enfermedades infecciosas que afectan a los elefantes, incluyendo virus como EEHV y Cardiovirus que causan hemorragias y muerte súbita, así como bacterias como Mycobacterium tuberculosis responsable de tuberculosis, y parásitos como la garrapata que transmite enfermedad de Lyme. El documento describe los síntomas, diagnóstico, tratamiento y prevención de cada enfermedad.
La pirámide alimenticia divide los alimentos en seis grupos principales y recomienda la cantidad diaria de cada grupo. Los grupos incluyen carbohidratos, vegetales y frutas, carnes y productos lácteos, y lípidos. Cada grupo provee nutrientes específicos y ejemplos comunes se dan para cada grupo. La pirámide busca promover una dieta balanceada y saludable.
The document discusses various topics related to water, including its chemical composition, the human body's water content, and water pollution. Water is an oxide of hydrogen with a 2:1 hydrogen to oxygen ratio that can dissolve most substances, making it a universal solvent. The human body and plants both contain around 60% water. Water pollution occurs when harmful substances like acids, detergents, crude oils, or fertilizers are discharged into the environment in quantities that are damaging to human health. Common sources of water pollution include industrial waste, agricultural runoff, oil spills, and refuse and sewage.
El documento habla sobre la gestión de inventarios en los laboratorios escolares. Explica que al inicio de cada semestre, el auxiliar de inventarios realiza un conteo físico de todos los elementos para llevar un registro y control. Luego, durante el semestre el coordinador supervisa periódicamente el inventario. Al final del semestre, se realiza un inventario de cierre donde los docentes firman un acta para dejar constancia del estado de los elementos.
Policy Briefing - Sanitation Research Symposium, Kenya (April 2015)Edward K.R. Ikiugu
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INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
This study assessed the influence of healthcare provider competency on universal health coverage utilization in Seme Sub-County, Kenya. A cross-sectional study was conducted using a sample of 377 community members and 8 health facility managers. Logistic regression found that healthcare provider competency statistically influenced utilization of universal health coverage. Respondents who perceived that providers had adequate health knowledge were over twice as likely to use universal health coverage services. Those who experienced misdiagnosis were half as likely to solely rely on universal health coverage. Most respondents agreed that providers had sufficient knowledge, though some raised concerns about competency in pharmacy departments due to staffing shortages. In conclusion, healthcare provider competency levels significantly impact utilization of universal health coverage.
Assessment of community utilization of chps services in komenda edina-eguafo...Alexander Decker
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Factors Affecting Consumer Health Care Services Delivery in Private Health Fa...AI Publications
Background: In 2007, the government of the republic of Tanzania has launched the Primary Health care services development programme as one of the renewed efforts to effectively engage the healthy sector in poverty reduction strategies. The study was dealing with evaluation on the factors that affects health services delivery to private hospital facilities Method: Data was collected from 169 patients who are customers of KMH and two sampling techniques were used, namely purposive sampling and random sampling. The study use questionnaire and interviews together with documentary review together information concerning the study objective. Quantities data were analyzed through SPPS data were coded ruined to observe to which percent the variables were significant or not significant towards research objectives. Results: The study finding that there are factors that are challenges towards delivering health services to patients including absence of good communication, customer care, shortage number of health professionals and most of patients are not attended on time, however on other hand study discover that there factors pull health services delivery including presence of social media, good infrastructures that support patients from far and presence of NHIF services to KMH. Recommendations: This study recommends that Private Public Partnership should be more emphasized and applied in health sector for the aim of improving health survives delivery to patients. Conclusion: The study concludes that although much has been done over many years to restructure the health care system and to improve the quality of care being rendered to patients, the literature reveals that a lot of people in Mwanza city still suffer from getting quality health services from health facilities including hospitals which are owned by private institutions.
The Positive Impact of Public Health Midwives for Nations Wellbeing through P...ijtsrd
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A Study to Assess the Effectiveness of Planned Teaching Programme on Environm...ijtsrd
Background Environmental health the branch of public health concerned with monitoring or mitigating those factors in the environment that affect human health and disease. Or other words the condition of the environment in a particular region, especially as regards ecological diversity or pollution. Objectives The aim of this study was to assess effectiveness of planned teaching programme on environmental health among the community people. Methodology The research approach adopted for this study is a Quantitative research approach. The research design was pre test and post test design. The pilot study was conducted at Rural Area Gandhi Nagar Bhopal. A Convenient sampling technique was used. Structured knowledge questionnaire was used to assessing the environmental Health. The final study was conducted with 50 sample in schools was given followed by post test after 7 days using the same pre test tools. The data collected was analyzed using inferential statistics. Results Indicated overall pre test and post test mean knowledge scores on environmental health. Depicted mean post test score 24.95 is higher than mean pre test score of 16.825. The actual gain knowledge score is 8.125 and post test SD =3.25, pre test SD=4.50 and computed paired t test 9.3235 p= 2.04 at the level of 0.05. Thus, data showed higher than the tabled value t test = 2.18 at the level of 0.05 thus indicated significant difference and effectiveness of planned teaching program, in increasing the knowledge of Community people regarding environmental health. The computed ”˜t’ value t=9.3235 was higher than the table value t=2.04 at 0.05 level of significance. Hence, the research hypothesis H1 was accepted. Conclusion The study concluded that planned teaching program was effective in increasing the knowledge score of Community people regarding environmental health. Ms. Sunita Singh | Mr. Mata Deen | Mrs. Malika Roy "A Study to Assess the Effectiveness of Planned Teaching Programme on Environmental Health among the Community People in Selected Rural Area Gandhi Nagar Bhopal (M.P.)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-4 , June 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50349.pdf Paper URL: https://www.ijtsrd.com/medicine/other/50349/a-study-to-assess-the-effectiveness-of-planned-teaching-programme-on-environmental-health-among-the-community-people-in-selected-rural-area-gandhi-nagar-bhopal-mp/ms-sunita-singh
This toolkit is designed to support climate change practitioners in the Pacific islands region to integrate gender into their programmes and projects. It is aimed at climate change professionals working in national governments, non-governmental organisations, regional and international organisations who are involved in managing and implementing climate change programmes.
While many of us are aware that gender does matter for sustainable development and climate change adaptation and mitigation, we may not know clearly how it matters, and what tools are available that can help to assess how it matters. Knowing is also not enough: we must apply this knowledge in a practical way when we design and implement activities, and ensure that we are capturing useful and important information through our monitoring and evaluation frameworks.
This toolkit provides advice at a practical level, to address these needs. The principles and practices proposed in this toolkit are based on many decades of experience in the integration of a gender perspective in sustainable development, natural resources management and disaster preparedness. The toolkit is divided into three parts. This introductory module explains why gender is a critical consideration in climate change programmes, projects and strategies, and clarifies some common misconceptions. Module 2 focuses on the links between gender and climate change in specific sectors (e.g. food security, water and energy); and uses sector-relevant case studies to explain how to take gender into consideration.
It also includes a module on disaster risk reduction recognising that these interventions should be factored into all climate change adaptation programmes and projects. These sector chapters can also be used as stand-alone documents for practitioners to guide their analysis in a specific sector. Module 3 is the ‘how-to’ section and will take you through the different phases of a typical climate change programme/project cycle, identifying potential entry-points for integrating gender in each phase and also includes a generic gender checklist that may be applied to programmes and projects. This toolkit will not make you a gender expert! However, it provides guidance along with links to other resources that can help strengthen your knowledge about gender and climate change.
This qualitative study examined community members' knowledge of emergency medical conditions like obstetric and neonatal complications in northern Ghana. The study aimed to understand barriers to utilizing emergency referral services and inform the development of a community education program. Focus group discussions revealed varying and sometimes inaccurate understandings of different medical emergencies. Certain conditions were believed to be spiritual or traditional problems requiring non-medical treatment. The discussions identified misconceptions and cultural practices that hindered emergency care seeking. The results provided guidance on addressing knowledge gaps and misperceptions through community education materials and programs to improve emergency service utilization.
The influence-of-monitoring-and-evaluation-on-water-project-performance-in-mi...oircjournals
In a 2010 study by World Bank, it was evidenced that people lack proper services because systems fail, often because not enough resources are invested to appropriately build and maintain them, and also because of the stress that the fast growing population places on the existing infrastructure. According to Migori county report card in 2016, it was established that there was lack of continuity in water projects commenced and that construction of water projects does not help if they fail after a short time. This study analyzed the influence of community participation on water project performance in Migori County. The study specifically; examined influence of communication, management skill, technology and monitoring and evaluation on water project performance. The conceptualization of the study was guided by Resource dependence, the theory of Change, System theory and the Theory of Constraints. The study applied descriptive approach through survey design. The target population comprised of 228 stakeholders and water service company staffs working on water project in Migori County. The sample size of the study was 145 respondents arrived at using a 1967 Taro Yamane’s formula of sample size determination. Data analysis was done by descriptive statistics. The study revealed that monitoring and evaluation is statistically significant influence on water project performance (β=0.152, p<0.05). The study concluded that project managers have adequate and experience in project management. Projects have clear documentation and the company has project progress reports. The study recommends that county government should empower project managers at County levels to improve planning and implementation towards the goal of sustaining water projects benefits, Non-Governmental Organizations to evaluate the performance and sustainability of water projects vis a vis the community participation at all stages of the project cycle.
Integrating CTC in health care delivery systems in Malawi (Special Supplement...ssuserb3b109
The document summarizes a pilot program in Malawi that integrated Community-based Therapeutic Care (CTC) into the existing health system to treat malnutrition. The program decentralized services through health centers and community networks. Outcome indicators showed high coverage and cure rates. However, fully integrating the program posed challenges, such as strengthening supervision, stock monitoring, and communication between community and health structures. The success of the pilot provides opportunities to address malnutrition and support those with HIV/AIDS in a more sustainable way through local management and community networks.
The document describes a research project conducted in Zambia to understand the socio-cultural and gender contexts of maternal survival. The project involved qualitative research, policy reviews, and convening intersectoral stakeholder meetings ("Interest Group Meetings") at the central and provincial levels. These meetings aimed to stimulate discussion and advocacy on maternal health issues. The engagement was more successful at the provincial level, with participation from various sectors. However, engagement declined over time at the central level. The document highlights the potential value of intersectoral stakeholder discussions throughout the research process to promote information sharing, alliance building, and translating research into action.
MONITORING AND EVALUATION PRACTICES AND PERFORMANCE OF DEVOLVED GOVERNMENT FU...AJHSSR Journal
ABSTRACT :The purpose of the study was to determine the Monitoring and Evaluation practices and
Performance of Devolved Maternal Health Care Projects in Kenya. The study sought to determine the extent to
which M&E human resource capacity development, mobilization of M&E funding, organizational cultural
practices and involvement of stakeholders in monitoring and evaluation influences the performance of devolved
maternal health funded projects in Likoni Sub County, Mombasa County. The study adopted descriptive
research design. The target population was 8,725 drawn from various County Department units, County Health
workers and the projects beneficiaries. The study employed a sample size of 544 derived from the Yamane
(1967) formulae. Stratified sampling was applied while choosing the sample size. The researcher employed
questionnaire guide to collect the data which was analyzed quantitatively using both descriptive and inferential
statistics. The data collected was analyzed using Statistical Package for Social Science (SPSS) statistical tool.
The study concluded that all the factors were considered critical in the enhancement of project performance for
the maternal health care. The study recommends that there should be institutionalization of M&E, prioritization
of M&E funding and ring fencing of the funds in all the projects that are being undertaken.
KEYWORDS: Maternal health care projects, Stakeholder involvement, Monitoring & Evaluation, Devolved
government, Organizational culture
This systematic review examines pathways to recover from open defecation (OD) in communities that have achieved open defecation free (ODF) status through community-led total sanitation and hygiene (CLTSH) interventions. The review assesses outcomes and impacts of ODF status on disease reduction, identifies challenges that can lead to ODF reversion, and explores options for maintaining ODF status over the long term. A comprehensive search of published and unpublished literature from 2007 to 2018 in multiple languages and databases was conducted. Key findings related to CLTSH implementation characteristics, obstacles to maintaining ODF status, and recommendations for effective long-term ODF are discussed.
A retrospective review of the Honduras AIN-C program guided by a community he...HFG Project
Factors that influence performance of community health workers (CHWs) delivering health services are not well understood. A recent logic model proposed categories of support from both health sector and communities influence CHW performance and program outcomes. This logic model has been used to review a growth monitoring program delivered by CHWs in Honduras, known as Atención Integral a la Niñez en la Comunidad (AIN-C). A retrospective review of AIN-C was conducted through a document desk review and supplemented with in-depth interviews. Documents were systematically coded using the categories from the logic model, and gaps were addressed through interviews. Authors reviewed coded data for each category to analyze program details and outcomes as well as identify potential issues and gaps in the logic model.
Keynote address by Dr. Eric Goosby of UCSF, presented at CFAR HIV Research in International Settings (CHRIS) meeting in San Diego, October 1, 2014. Dr. Goosby discussed. "Global Health Delivery and Diplomacy: The Long Road to Sustainable Programs."
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
1. The document summarizes Nepal's Health Sector Implementation Plan 2 (NHSP-IP 2), which aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and quality of essential health services.
2. Key goals of NHSP-IP 2 included reducing morbidity and mortality from common health problems by ensuring accessible, affordable, quality health care services.
3. The plan outlined strategies, programs and services, roles of non-state actors, and approaches to structure, financing, research and monitoring of Nepal's health system.
4. While progress was made in areas like immunization and reducing child and maternal mortality, challenges remained such as disparities in access, sustainability of financing
Similar to What Lessons for Sustainability of Maternal Health Interventions Can Be Drawn from Rural Water And Sanitation projects (20)
What Lessons for Sustainability of Maternal Health Interventions Can Be Drawn from Rural Water And Sanitation projects
1. Journal of Management and Sustainability; Vol. 5, No. 2; 2015
ISSN 1925-4725 E-ISSN 1925-4733
Published by Canadian Center of Science and Education
97
What Lessons for Sustainability of Maternal Health Interventions Can
Be Drawn from Rural Water And Sanitation Projects?
Perspectives from Eastern Uganda
Suzanne N. Kiwanuka1
, Moses Tetui1
, Asha George2
, Angela N. Kisakye1
, David R. Walugembe1
& Elizabeth
Ekirapa Kiracho1
1
Department of Health Policy Planning and Management, School of Public Health, Makerere University,
Uganda
2
Department of International Health, Johns Hopkins School of Public Health, Uganda
Correspondance: Suzanne N. Kiwanuka, Makerere University School of Public Health, New Mulago Hospital
Hill complex, Kampala, Uganda. Tel: 256-772-886-377. E-mail: skiwanuka@musph.ac.ug
Received: February 26, 2015 Accepted: April 23, 2015 Online Published: May 31, 2015
doi:10.5539/jms.v5n2p97 URL: http://dx.doi.org/10.5539/jms.v5n2p97
Abstract
Background: Sustainability of health interventions is a global concern, as program benefits are lost as soon as
programs lose donor funding. An assessment of the Uganda Rural Water and Sanitation (RUWASA) project
revealed that program gains can be sustained decades later. We analysed RUWASA implementation to draw
sustainability lessons for maternal and child health interventions in Uganda.
Methods: Administrative data from 1997 was combined with key informant interviews and focus group
discussions in Kamuli and Pallisa undertaken in 2012. Data on borehole installation, coverage of safe water and
latrine construction before and after the termination of the RUWASA project was obtained.
Results: Latrine coverage increased from 24% (2001 project end) to 68% (2011) in Pallisa and from 60% (2001
project end) to 83% (2011) in Kamuli districts. Access to safe water increased from 7% (2001 project end) to
68% (2011) in Pallisa and from 38% (2005 project end) to 67% (2011) in Kamuli districts during RUWASA and
after it was terminated. Factors crucial to the sustainability of the project included; involvement of communities,
community contributions towards installation of the boreholes and mandatory prerequisite of installation of pit
latrines by all households prior to borehole installation.
Conclusions: Community engagement, contributions, use of structures and ownership of RUWASA was critical
for the sustainability of the intervention. These are critical lessons for sustainability of maternal and child health
programs.
Keywords: sustainability, maternal health interventions, Rural Water and Sanitation Projects, Uganda
1. Introduction and Background
Sustainability in its simplest terms is defined as the “capability of being maintained at a certain rate or level”
(Gruen et al., 2008). For some, it refers to being financially self-sustaining, and financial sustainability is an
important concern (Katz, Glandon, Wong, & Kargbo, 2013; Odame, Akweongo, Yankah, Asenso-Boadi, &
Agyepong, 2013). With regards to program sustainability, a number of terms have been used interchangeably
(e.g., continuation, institutionalization, resilience, integration, capacity building) Gruen et al., 2008;
Shediac-Rizkallah, and Bone, 1998),yet they are not synonymous. It is a complex concept marshalling together
various elements, for example “the ability of a project to function effectively, for the foreseeable future, with
high treatment coverage, integrated into available health care services, with strong community ownership using
resources mobilized by the community and government (WHO, 2002).” Going beyond individual projects,
sustainability requires attention to broader organizational and systems dynamics and as such is also defined as
“the long term ability of an organizational system to mobilize and allocate sufficient and appropriate resources
(manpower, technology, information and finance) for activities that meet individual or public health needs and
demands (Olsen, 1998).”Accordingly, several reviews stress its dynamic nature fuelled by interactions between
stakeholders, institutions and program targets, ensuring continuation through adaptations to broader
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98
environments (Shediac-Rizkallah, 1998; Gruen et al., 2008; Stirman et al., 2012). The most recent systematic
review of the field, Stirman et al. (2012) found that one of the most cited frameworks is that of
Shediac-Rizkallah and Bone (1998), which proposed a model through which sustainability can be viewed from
three different perspectives. These include the health promotion perspective, which emphasizes the maintenance
of health benefits over time; the organizational change and innovations perspective, which views the longevity of
service delivery programs as being due to a balance of adaptation, institutionalization and integration into by
existing systems, and the community development perspective that focuses on the capacity of communities to
maintain changes in behaviour. The framework proposes that sustainability is affected by (i) aspects of program
design and implementation, (ii) attributes of organizational setting and (iii) factors in the broader environment
(Shediac-Rizkallah & Bone, 1998).
Figure 1. Sustainability framework adopted from Shediac-Rizkallah & Bone (1998)
Our literature search only found two articles that explicitly analyse the sustainability of maternal health programs
in low and middle-income contexts. In China, the importance of program champions, local support, staffing
levels, institutionalization and adaptation to local contexts were critical in sustaining improvements in maternal
and child health (Edwards & Roelofs, 2006). In Tanzania, important determinants included efforts that built
community capacity and that mobilized both informal and formal systems in communities (Ahluwalia, Valley,
Gieseker, & Kabakama, 2010). Despite the contributions of these two articles, the paucity of evidence regarding
the sustainability of maternal health programs limits evidence informed planning for future programs. The Rural
Water and Sanitation (RUWASA) project was implemented for 10 years in a population of approximately 4
million in eight districts. The project had a year long planning phase in 1990 with implementation starting in
1991. The main objective of the project was to reduce the prevalence of water related diseases through the
provision of clean water and the promotion of hygiene practices and sanitation facilities. The project used several
different types of technology to promote access to safe water. They included natural spring protection, borehole
rehabilitation, hand-augured wells and hand dug wells, and deep boreholes. The ease of maintenance and
community contribution were some of the factors that determined the type of technology that was used.
Promotion of hygiene and sanitation involved mainly provision of education and construction of pit latrines. The
strategies employed by the project to ensure sustainability included community participation and ownership,
involvement of women, use of affordable and maintainable technology, hygiene education and sanitation as well
as ensuring on going monitoring and evaluation (Mutono, 1995; Campbell, Benova, Gon, Afsana, & Cumming,
2015). Given the paucity of the literature, in order to seek contextually relevant lessons on sustainability for our
own maternal health interventions, we sought to explore the factors that supported the sustainability of other
community-based programs in our study sites. These lessons are drawn from the RUWASA program initiated in
two districts in Uganda in 1995.
This paper documents evidence of RUWASA’s sustained program achievements and identifies factors that
explain its sustainability. It uses the frameworks on sustainability discussed earlier (Gruen, 2008;
Shediac-Rizkallah & Bone, 1998; Stirman et al., 2012) and categorizes findings according to i) program design
related to inputs and start up, such as financial and delivery arrangements, related training and involvement of
local stakeholders; ii) visible benefits generated by the program iii) organizational and institutional elements
including program champions and iv) broader socio-political and other environmental factors. The discussion on
these is embedded with lessons on how RUWASA’s experiences can be adapted for community based maternal
health interventions. This paper draws sustainability lessons for maternal health projects using a case study on
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99
the implementation of RUWASA programmes in Uganda.
2. Methods
Uganda is found in East Africa and has a population of approximately 37 million people as of 2014, 75% of who
live in rural areas. The study was conducted in two rural eastern Uganda districts –Kamuli and Pallisa. Kamuli
has a population size of about 640,000 and Pallisa about 530,000, both districts have a fertility rate average of 6
children per woman. The main livelihood in these districts is subsistence farming with slow growing townships,
which offer opportunities for small scale trading. These districts were purposively selected because they
participated in the RUWASA and were also sites for the transport and maternal health services vouchers study
undertaken by Makerere University School of Public Health (MakSPH).
Table 1. Descriptive indicators for Kamuli and Pallisa districts 2013
District Area Sq
meters
Population Sub-counties Main Activity ANC Deliveries PNC
Kamuli 133 639,936 12 Subsistence
farming
54% (4 visits) 40% 48%
Pallisa 1,461 530,570 28 Subsistence
farming
43% (4visits) 62% 35%
The explanatory study design drew on quantitative and qualitative data collected from existing program
documents, key informant interviews and focus group discussions. Data on water and sanitation activities and
achievements since 1997 to 2011 was extracted from district annual reports. Three key informant interviews
were conducted with participants (program managers and officers) who held key positions in the RUWASA
project for a period on over ten years identified through the process of snowballing. These two data sources
informed the interview guides used for three focus group discussions, one in Kamuli and two in Pallisa district to
elicit community views on what made the RUWASA program sustainable in March 2012. The respondents
included men and women with 8 participants in Kamuli, and 10 in Pallisa. Interview and focus group data was
collected in the local language by national researchers with experience in qualitative research. Interview guides
focused on explanatory factors underlying sustainability of RUWASA interventions at community, organizational
and broader socio-political or environmental levels. Data was recorded digitally, transcribed and translated into
English by national researchers. Thematic analysis of interviews and focus group data was led by national
researchers using a framework that focused on our programmatic concerns: determinants of sustainability.
Although, we used a framework that highlighted the key areas of investigation, we also looked out for new
themes emerging outside this framework (Campbell et al., 2006). The themes identified were in line with the key
issues that the research sought to address, such as community, organizational and broader socio-political factors
underlying the sustainability of interventions. We analysed both facilitating factors, including visible benefits, as
well as challenges encountered.
2.1 Limitations
Retrospective interviews on events and processes in the past are necessarily partial and subjective. We have tried
to counter this bias by triangulating the perspectives of key informants with community viewpoints, contrasting
primary with secondary data in the form of program documents, inclusion of negative evidence and prolonged
field site engagement, all of which are markers of trustworthiness in health systems research (Gilson et al., 2011).
Although some of the results that we mention could be partially attributed to other programs other than
RUWASA, during the interviews the key informants acknowledged that RUWASA was the main player
responsible for increasing access to safe water and latrine coverage even after the end of the project. The sample
size for our primary data (3 key informant interviews and 3 FGDs) is small, but we complimented this with
longitudinal administrative data. Our research aim was to develop an illustrative case study on which to base
analytical generalization and hypothesis for future research, an important endeavour in health systems research.
The data that we have presented does not look at sustainability of outcomes, such as decrease in water related
diseases but rather at outputs such as installation and maintenance of boreholes and increased latrine coverage.
2.2 Ethical Considerations
The study was cleared by the Makerere University School of Public health Ethical Review Committee as well as
the Uganda National Council for Science and Technology. Permission to conduct the study was obtained from
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100
the district authorities and informed consent from the study participants.
3. Results
3.1 Sustained Water and Sanitation Achievements in Eastern Uganda
The implementation, duration and achievements of RUWASA during the donor funded phase and thereafter are
shown in figures 2 to 4. Findings show a marked improvement in the number of boreholes drilled and the
percentage coverage of latrines and access to safe water in the two districts of Pallisa and Kamuli from 1997 to
2011.
Figure 2. Bore holes drilled between 1997 and 2011 according to district annual reports, Local Government of
Pallisa and Kamuli
At the start of the project in 1997, Pallisa had 9 boreholes drilled, by the end of the project in 2001, they reached
a total of 21, which kept increasing steadily to a total of 320 in 2011. In Kamuli, they started with 421 boreholes
drilled, 557 at the end of the project in 1999 and reached 1023 in 2011.
Figure 3. Safe water access coverage between 1997 and 2011 according to Local Government of Pallisa and
Kamuli
In 1999 and 2001 when the project ended in both districts, safe water coverage only increased by a very small
increment, 7% and 6% in Pallisa and Kamuli respectively. However, this trend continued so that by 2011, they
were both above 65% long after the end of the project.
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Figure 4. Latrine coverage between 1997 and 2011 according to district annual reports, Local Government of
Pallisa and Kamuli
Similarly, latrine coverage improved over the years with Pallisa starting at 7% in 1997, 24% when the project
ended in 2001, and over 65% by the end of 2011. The same trend of increasing coverage is noted for Kamuli
after the end of the project.
3.1.1 Contributors to the Sustainability of the Water and Sanitation Project in Eastern Uganda
Drawing from the qualitative interviews, we present in this section factors identified by respondents as
contributing to sustainability in terms of project design and implementation, visible benefits, organizational and
institutional elements; and broader socio-political factors.
3.1.2 Project Design: Inputs and Start-Up
From the beginning, district officials and communities participated in needs assessment and priority setting
exercises. Communities continued to participate in developing work plans for operating and maintaining the
infrastructure. Such close involvement on the terms of the initiatives built the trust and buy-in that subsequently
secured a range of community inputs. While an external funder initially financed most of the program with
minor contributions from households, after five years the government took over key funding for the project.
Despite government support, co-funding for the project was maintained drawing from community resources and
sustaining community ownership. Even if initially difficult, providing land, manpower and contribution towards
capital and maintenance costs meant that the boreholes belonged to the communities. This is demonstrated in the
quotes below.
Woooooh…. people are used to free things but they do not value what they are given for free. They will always
expect more free things and in such a situation even repairs of boreholes have to depend on the donor, but here
we did it differently and I think it helped. Having a borehole in one community motivated neighbouring
communities to contribute towards their own borehole and people were somehow competing. I think demand
increased for boreholes because of this. (KI Kamuli).
People hated me because I was telling them that they needed to pay some money for the water (KI Pallisa)
Haaa…in the beginning it was like a punishment but later collecting money from community became easy
because people paid quickly (Female FGD participant Pallisa).
Apart from providing inputs, communities also received inputs that built their capacity to sustain the
interventions. The training of handbag mechanics within communities ensured that borehole breakdowns were
addressed in a timely manner. These mechanics operated and were paid privately under terms negotiated by
water user committees. Trainees were selected by communities at sub-county levels and trained by the district
authorities. Women were given preference and were trained for free, since they were seen to be more likely to
stay with communities as demonstrated by the quote below.
People want to train someone who will not run away with the skills (KI Pallisa)
Women are committed. We have one here (a handbag mechanic) who has stayed for more than 10 years and she
is training others (KI Pallisa).
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3.1.3 Visible Benefits
Right from the beginning most of the boreholes were productive. Furthermore, spin-off visible benefits included
the ability to grow vegetables within compounds due to improved sanitation and the availability of community
savings that could be drawn upon for other uses. Having visible rewards that support community members more
broadly are key additional motivation factors sustaining support for the intervention.
3.1.4 Organizational and Institutional Elements
Community structures were established to support the interventions and supporting the active role of program
champions. Water Development Committees ensured that contributions were made and use of funds monitored
so that communities could repair any boreholes which became incapacitated. The methods of collecting money
and its use varied from district to district but most importantly the communities themselves made these decisions.
The committees collect money monthly or whenever the borehole broke down.
The people decide how to do it. We advised them to have money always available, but sometimes it is hard, so
this varies from community to community. ……they have lists of all users to enable quick collection if there is a
problem with the borehole (KI Pallisa).
Money is collected from users monthly about 500shs to 2000shs and managed by these committees. This helps to
quickly repair any borehole which breaks down. In fact some of this money has been used to lend small business
owners (KI Kamuli).
The establishment of community by-laws that linked water and sanitation was another driving force for
sustainability….because water and sanitation were tied together…. I think this was very wise. The by –law
required every household in a community to have a pit latrine and then they could get a borehole of course after
contributing the money also (KI Pallisa).
The command was that without latrine, no borehole. After getting latrines women could get vegetables from
anywhere in their compounds (because communities no longer defecated indiscriminately) and this helped a lot.
(Female FGD participant Kamuli).
Broader socio-political factors
According to respondents, community sensitization and involvement at all levels of decision making regarding
installation of boreholes was one of the most important ingredients which contributed to the success and
sustainability of RUWASA.
Well-mobilized communities are receptive to things they benefit from. Once you create awareness, you increase
ownership and then something can last. (KI Pallisa)
Community sensitization is a must to instil a sense of ownership and to build capacity, sometimes people do not
know what is good for them (KI Pallisa)
Table 2. Summary of contributors to the sustainability of RUWASA
Program design:
inputs and start up
Visible benefits Organizational and institutional elements Broader socio-political
factors
Pallisa
Broad community participation in
development of work plan for
operation and maintenance.
Training of communities on safe
water chain and handbag
mechanics within the community
to conduct borehole repairs.
Co-payments- communities
contribution to 2% capital and
maintenance costs built pride and
ownership.
Savings that led to
small business
ventures.
Program champions in the form of Water and
Development committees spearheaded the
initiative, particularly following up on
co-payments for borehole maintenance.
Communities developed list of eligible
community users for quick mobilization of
additional resources when needed.
Conditional delivery arrangements which
stipulated that for a community to get a bore
hole each household in its community (80-200
households) had to have a pit latrine.
By-laws created by communities to ensure
adherence to sanitation requirements and water
use.
Preference given to female handbag mechanics
to ensure retention of skills within community.
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Kamuli
District officials and communities
participated in needs assessment
and priority setting exercise.
Co-payments-communities
contribution to capital and
maintenance costs built pride and
ownership.
Ability to grow
vegetables in the
compound due to
improved sanitation.
Integration or coupling of water with sanitation
Water User committees collected monthly fees
500-2000 Ugandan Shs for borehole
maintenance while people outside that
community paid more (funds collected could
be used to lend community members to start
small scale businesses.)
Intense sensitization using
community development
officers selected by
community
3.1.5 Challenges to the Sustainability of the Water and Sanitation Project in Eastern Uganda: Inputs and Benefits
Once government took over the project, they increased the financial charge for communities, making it harder
for communities to complete their contributions. There was also some misuse of funds, but that was overcome.
Community support also wavered when some of the wells were not productive or yielded salty water.
Misuse of funds (by water user committees) has been reported but it is not common (KI Kamuli)
3.1.5.1 Organisational and Institutional Factors
Additional challenges arose from the separation of the water component fromthe sanitation component, with the
Ministry of Health responsible for sanitation through households and Ministry of Education responsible for
sanitation through schools. This reorganisation resulted in less funding for the latter.
3.1.5.2 Broader Socio-Political Factors
While community respondents perceived the political environment to be supportive of community initiatives, for
politicians this might have served to foster their political success. However, key informants within RUWASA
interpreted political involvement as political interference. In their view politicians frequently disrupted
established community efforts, such as mandatory community contributions towards borehole maintenance
through payment of levies, by pledging to meet these costs themselves, which was not sustainable.
Politicians are the ones encouraging dependence among the people for example one politician told his people to
contact him whenever the borehole breaks down. Now what if he is not in the country, what if his term of office
ends? And now people stop contributing because of these self serving promises? (KI Pallisa).
Table 3. Challenges to the sustainability of RUWASA
Program design:
inputs and start up
Visible benefits Organizational and institutional
elements
Broader socio- political factors
Pallisa
Operations and management
challenges such as misuse of
funds and delays in borehole
repair.
Some boreholes
have low yield
or salty water.
Sanitation was separated from
water and administered by
separate Ministries
Political interference in the form of
politicians disrupting already set priorities to
influence areas where boreholes can be
planted in their favor.
Dependence on politicians ie politicians
actions threatened established sustainable
community practices of contributing towards
borehole maintenance by promising to make
the repairs themselves.
Kamuli
Misuse of funds noted but
minimal
Capital contribution (2%) charge
increased from 180,000 to
200,000 after government took
over.
Some boreholes
have low yield.
Sanitation was separated from
water and funding for sanitation
is selective
Politicians were also noted to be disruptive of decision making processes around the choice of location for new
boreholes. In trying to influence voters they pushed for boreholes to be installed in their constituencies instead of
honouring the established criteria for placement in terms of contributions and meeting sanitation targets.
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During campaign season some politicians come in and want to influence priorities for boreholes because they
want votes. They ask “why isn’t this borehole taken to this place (their own area)? And they push to get more
boreholes in their areas which causes to lack of trust and morale among the people. (KI Pallisa)
4. Discussion
Improvements in maternal health indicators have been achieved globally (Hogan et al., 2010; Velleman et al.,
2014) through diverse strategies. These include increasing the number of deliveries attended by skilled personnel,
providing safe delivery kits, providing financial support, and providing transport for expectant mothers among
others. Most of these initiatives however, have been project based with a high risk of not being sustainable. The
lack of evidence on how to sustain successful program based initiatives poses a threat to the maintenance of
achieved health goals. It entails a waste of valuable resources, in terms of financial investments, infrastructure,
human resources and not least jeopardizes community support and trust (Gruen et al., 2008)
In this paper, we focus on the sustainability of community based programs with particular reference to
RUWASA’s role in increasing access to safe water and promoting sanitation through the construction and
maintenance of bore holes and latrines. Key contributors to the sustainability of RUWASA activities years after
initial donor funding are linked to the type of relationships developed. Community participation in designing,
planning and decision making throughout the project and community monetary and in-kind contributions (land
and manpower) towards capital and management costs supported ownership over the activities. Incentives
further supported activities since communities not only received skills, but also visible benefits in terms of
improved access to water, vegetable gardens and finances for other activities. Such gains were also reaped
through community champions and structures that sustained community contributions, by-laws and widespread
community sensitization. Synergies between these different factors fostered a sense of ownership for the
boreholes and community pride in their achievement. At the same time, key challenges included the lack of
productivity of some of the boreholes; some fraud in the management of funds generated under the project;
organizational changes that separated management of water from sanitation; and political interference. The
program had to change and adapt in aspects related to program design as well as factors in the broader
environment in order to be maintained. These factors central to sustainability are discussed below and lessons
which can be drawn for maternal health are highlighted.
4.1 Project Design: Institutionalisation, Decision Making and Implementation
According to Bossert (1990) and Shediac-Rizkallah (1998), strong institutions are critical to the sustainabilitiy of
interventions. By implementing RUWASA through strong institutions such as district leadership structure and
community selected committees, RUWASA was built on a more secure foundation. Early and continuous
engagement of communities through their leaders ensured that the decisions made such as collecting borehole
user fees were ultimately owned by communities. For maternal health interventions there is a need to identify
strong community structures that could be harnessed to champion the cause of maternal health particularly in
rural communities for better sustainability. Most maternal interventions particularly in Uganda and other low and
middle income countries have been vertically designed and implemented resulting in terminated benefits over
time.
4.1.1 Community Contributions and Innovations
Although external funding was initially used for the program with minor contributions from households, after
five years the government took over key funding for the project. This co-funding for the project was maintained
drawing from community resources and sustaining community ownership. In Uganda the onus to improve
maternal health outcomes has been solely and perhaps erroneously placed on the shoulders of government and its
implementers, the health workers and all responsibility has been removed from the households, women, men and
communities. Just as the responsibility of maintaining sanitation and provision of clean water was shared under
RUWASA, the responsibility for improving maternal health needs to be shared by both government and
communities. Absolving spouses and households from their responsibilities comes at too high a price for
governments in developing countries. Many governments often do not have sufficient resources to deliver
adequate health services. Although African governments agreed to contribute 15% of their budgets to health,
countries like Uganda, have not done this. In fact as demonstrated by RUWASA, communities which are
empowered, own and devote themselves to initiatives where they contribute in cash or in kind are more invested
in seeing the benefits of these initiatives sustained. The role of government here would be to support
communities and households to appreciate and actively contribute to decision making towards improved
maternal health by identifying community resources which can be tapped into to support this worthy goal. By
supporting innovations such as training of borehole “handbag mechanics” within the community, particularly
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women, RUWASA had a good shot at sustainability. In this case the recurrent costs of maintaining boreholes was
placed squarely on the shoulders of community which established borehole committees to impose a levy on
borehole users which then paid the mechanics. Moreover the choice of favouring the training of females
(considered to be more reliable in terms of not migrating from location to location) gave the community
investments in RUWASA more stable returns. For maternal health some of the key challenges have been
inadequate health worker numbers, long distances to facilities and shortage of supplies at facilities. Community
engagement under expert guidance could facilitate the identification of innovative approaches to mitigate these
challenges as has been documented in other settings.
4.1.2 Visible Benefits
To ensure sustainability, communities need to appreciate visible benefits of any project and seek to maintain
them. Right from the beginning most of the boreholes were productive. Furthermore, spin-off visible benefits
included the ability to grow vegetables within compounds due to improved sanitation and the availability of
community savings that could be drawn upon for other uses. Having visible rewards that support community
members more broadly are key additional motivation factors sustaining support for the intervention. Moreover,
having a functional borehole in one community motivated other communities to pursue the goal of having one,
thereby perpetuating a cycle of increasing latrine coverage in the region. For maternal health the benefits of
saving a mother’s life need to be appreciated by the broader community as extending beyond the household.
Maternal health projects pursuing sustainability need to educate communities about the benefits of saving a
mother’s and acquire their support in achieving this goal. Communities also need to be able to appreciate that
their efforts can contribute to the saving of mothers and new-borns. For example the community can contribute
money that can be used to increase finances that are required for ensuring access to maternal health such as
transport fees, maternal health needs, like clothing for the baby as well as supplies required for birth. In the
RUWASA project some of the spill over benefits included increased availability of food since more food could
be grown within the compound. Maternal health projects could also provide such spill over benefits for instance
community savings for meeting transport costs for maternal health services could result in more income for
transporters, hence creating incentives for continuity of care.
4.1.3 Community structures: Committees, Champions and By-Laws
The identification of program champions in the form of Water Development Committees, which spearheaded
change management for the RUWASA project and ensured that communities remained invested in its success
was important. On going challenges such as the separation of the water component from the sanitation
component headed by separate ministries (Health and Education respectively) could threaten successful
structures previously built. It was observed that this arrangement weakens community buy-in, which was
initially drawn from the merging of water and sanitation initiatives. This is in keeping with literature that reports
that local contextual factors can influence the success of interventions [Stirman, 2012 #540]. By laws such as the
requirement of all households to have a pit latrine propelled communities towards more active involvement. The
implication for maternal health is that locally instituted by-laws for instance those which require male
involvement or preparing birth items could potentially contribute to better household involvement in this region.
4.1.4 Broader Socio-Political Factors: Community Sensitization and the Role of Politicians
Community involvement and active participation in the setting of program goals and the visibility of the project
from inception to date were major contributors to community buy-in. While community respondents perceived
the political environment to be supportive of community initiatives and for politicians might have served to
foster their political success, key informants within RUWASA, interpreted political involvement as political
interference. This was because in an effort geared towards political expediency, politicians frequently obstructed
established community efforts such as the need for communities to contribute to borehole maintenance through
payment of levies by pledging to meet these costs themselves, which was not sustainable. Moreover the
democratic choice of location for new boreholes initially based on communities meeting sanitation targets was
also disrupted by this political interference. Politicians wield enormous influence for good or for bad and
implementers of maternal health programs should ensure that their influence is always harnessed positively. In
settings where politicians carry clout among communities this influence demands further study for its potential to
facilitate or hinder successful health initiatives. Health in general and particularly maternal health has long been
key campaigning points for many politicians. Politicians have a potentially big role to play as policy champions
in these settings and need to be engaged in order to acquire their buy-in and continuous support for programs. In
addition to rallying community support, political influence is also valuable in terms of agenda setting, and
mobilizing additional resources.
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4.1.5 Community Capacity
RUWASA placed the responsibility for sanitation and borehole maintenance on the community. This implied that
they ensured that the quality of these services was monitored and maintained. Community capacity to monitor
and ensure quality health services has been documented to be effective in rural settings in Uganda. It is certainly
a worthy strategy to pursue towards the sustainability of successful maternal health programs in Uganda and
elsewhere.
5. Conclusions
In conclusion, the lessons gleaned from RUWASA highlight the importance of community engagement in
planning, decision making and implementation of interventions. They also point to the importance of champions,
structures and potential support or harm that can emerge from political interference. Most importantly these
lessons indicate that although the responsibility for the delivery of maternal health services has long been
relegated to the government and health workers, perhaps this responsibility should not be left as fully belonging
to the government, particularly in resource constrained countries. Indeed, governments ought to be responsible
for providing funding for infrastructure, human resources and medical equipment and supplies costs. Community
institutions and structures on the other hand are crucial for the establishment of local leadership for maternal
health to carry the mantle for championing key issues. The need to sensitize communities to appreciate their
responsibility in averting maternal deaths cannot be over emphasized. In this regard male engagement is crucial
in ensuring the availability of household resources for maternal health since men typically control household
resources in Africa (Uganda Bureau of Statistics, 2006). Community innovations such as the use of existing local
transportation as referral transport for expectant women need to be encouraged. Clearly partnerships between
government and local communities would likely deliver better results for sustainability.
List of abbrevaitaions
RUWASA: Rural Water and Sanitation; MakSPH: Makerere University School of Public Health.
Competing interests
The authors declare no competing interests
Authors' contributions
SNK conceived the study, participated in its design and coordinated drafting of the manuscript. MT participated
in design of the study. AG participated in design of the study and helped with drafting of the manuscript. ANK
and DRW participated in drafting of the manuscript. EKK participated in designing the study and helped in
drafting the manuscript.
Authors' information
SNK is a Senior Lecturer at Makerere University School of Public Health, Kampala Uganda.
Acknowledgements
The authors extend their appreciation to the district leaders of Pallisa and Kamuli for their contributions to this
study in terms of accepting interviews, providing access to district records ad mobilizing communities for the
focus group discussions.
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