Suchergebnisse

Complex, area-based initiatives are a widely adopted policy response to problems of health inequalities and social exclusion in industrialized countries such as the UK and the US.This article explores the problems of evaluating such initiatives in a context of rapid national and local policy change by drawing on the Children's Fund, a UK government initiative that established local partnerships in each English local authority to promote children's social inclusion. It is suggested that independent local evaluations commissioned by the partnerships have had limited influence on programme design and implementation, and indeed have been highly contested in their use.The importance of dialogic engagement between evaluators and stakeholders is highlighted.

The extent of children's and young people's participation activities has increased considerably among statutory, voluntary and community sector organisations across the UK in recent years. The Children's Fund, a major government initiative launched in 2000, represents a systematic drive towards promoting children and young people's participation in planning, implementing and evaluating preventative services within all 149 local authority areas in England. Based on research carried out by the National Evaluation of the Children's Fund, this paper explores the experience of Children's Fund partnerships of engaging children and young people in strategic processes.

The extent of children's and young people's participation activities has increased considerably among statutory, voluntary and community sector organisations across the UK in recent years. The Children's Fund, a major government initiative launched in 2000, represents a systematic drive towards promoting children and young people's participation in planning, implementing and evaluating preventative services within all 149 local authority areas in England. Based on research carried out by the National Evaluation of the Children's Fund, this paper explores the experience of Children's Fund partnerships of engaging children and young people in strategic processes.

Synergies between securing sexual rights and the right to health have been pursued where there are clear public health gains to be made, such as lowering incidence of HIV and other sexually transmitted infections (STI). South Africa's 1996 Constitution outlawed discrimination on the basis of sexual orientation and promoted the right to health. This qualitative health policy analysis sought to understand why and how interventions to improve sexual health of lesbian and bisexual women and address sexual violence were initially proposed in the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 and why and how these concerns were deprioritised in the National Strategic Plan (NSP) on HIV, STIs and TB 2012-2016. A conceptual framework considered several determinants of political priority for the inclusion in NSP development in 2007 and 2011 around sexual health concerns of women who have sex with women. This article presents findings from 25 in-depth key informant interviews and document review and highlights results of application of categories for a framework on determinants of political priority for lesbian and bisexual women's issues to be included in South Africa's NSP including: actor power, ideas, political context and issue characteristics. The article demonstrates how the epidemiological and structural drivers of lesbian and bisexual women's vulnerability to HIV and STIs, including sexual violence and other violations of their sexual rights, have been expressed in policy forums and whether this has made an impact on lesbian and bisexual women's ability to claim the right to health.

Research demonstrates the important role of refugees and asylum seekers' social networks in providing both the practical and emotional support necessary to mitigate social exclusion and promote integration within receiving societies. Based on research conducted by the National Evaluation of the Children's Fund, we highlight the barriers to network building for refugee and asylum seeking children and families, and the ways in which Children's Fund strategies and practices are tackling these. Using the 'Indicators of Integration Framework' developed by Ager and Strang (2004), we describe the activity of Children's Fund services in relation to the concepts social bonds, social links and social bridges. Such attempts to reduce social exclusion are seen to have limited effectiveness when framed by a government policy context favouring the development of social bridges at the expense of social links and bonds.

BACKGROUND: In an era of increasingly competitive funding, governments and donors will be looking for creative ways to extend and maximise resources. One such means can include building upon professional advice networks to more efficiently introduce, scale up, or change programmes and healthcare provider practices. This cross-sectional, mixed-methods, observational study compared professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia. Primary healthcare units include a health centre and typically five satellite health posts. METHODS: One hundred sixty staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care. Network and actor-level metrics were calculated including density (ratio of ties between actors to all possible ties), centrality (number of ties incident to an actor), distance (average number of steps between actors) and size (number of actors within the network). Following quantitative network analyses, 20 qualitative interviews were conducted with network study participants from four primary healthcare units. Qualitative interviews aimed to interpret and explain network properties observed. Data were entered, analysed or visualised using Excel 6.0, UCINET 6.0, Netdraw, Adobe InDesign and MaxQDA10 software packages. RESULTS: The following average network level metrics were observed: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), number of ties 95.63 (SD 35.46), size of network 20.25 (SD 3.65). Advice networks for antenatal or maternity care were more utilised than advice networks for post-natal or newborn care. Advice networks were typically limited to primary healthcare unit staff, but not necessarily to supervisors. In seeking advice, a colleague's level of training and knowledge were valued over experience. Advice exchange primarily took place in person or over the phone rather than over email or online fora. There were few barriers to seeking advice. CONCLUSION: Informal, inter-and intra-cadre advice networks existed. Fellow primary healthcare unit staff were preferred, particularly midwives, but networks were not limited to the primary healthcare unit. Additional research is needed to associate network properties with outcomes and pilot network interventions with central actors.

BACKGROUND: Despite many efforts to achieve better coordination, fragmentation is an enduring feature of the global health landscape that undermines the effectiveness of health programmes and threatens the attainment of the health-related Sustainable Development Goals. In this paper we identify and describe the multiple causes of fragmentation in development assistant for health at the global level. The study is of particular relevance since the emergence of new global health problems such as COVID-19 heightens the need for global health actors to work in coordinated ways. Our study is part of the Lancet Commission on Synergies between Universal Health Coverage, Health Security and Health Promotion. METHODS: We used a mixed methods approach. This consisted of a non-systematic literature review of published papers in scientific journals, reports, books and websites. We also carried out twenty semi-structured expert interviews with individuals from bilateral and multilateral organisations, governments and academic and research institutions between April 2019 and December 2019. RESULTS: We identified five distinct yet interconnected sets of factors causing fragmentation: proliferation of global health actors; problems of global leadership; divergent interests; problems of accountability; problems of power relations. We explain why global health actors struggle to harmonise their approaches and priorities, fail to align their work with low- and middle-income countries' needs and why they continue to embrace funding instruments that create fragmentation. CONCLUSIONS: Many global actors are genuinely committed to addressing the problems of fragmentation, despite their complexity and interconnected nature. This paper aims to raise awareness and understanding of the causes of fragmentation and to help guide actors' efforts in addressing the problems and moving to more synergistic approaches.

BACKGROUND: The Paris Declaration on Aid Effectiveness, which provides an international agreement on how to deliver aid, has recently been reviewed by the Organization for Economic Co-operation and Development (OECD). Health sector aid effectiveness is important, given the volume of financial aid and the number of mechanisms through which health assistance is provided. Recognizing this, the international community created the International Health Partnership (IHP+), to apply the Paris Declaration to the health sector. This paper, which presents findings from an independent monitoring process (IHP+Results), makes a valuable contribution to the literature in the context of the recent 4th High Level Forum on Aid Effectiveness in Busan, Korea. METHODS: IHP+Results monitored commitments made under the IHP + using an agreed framework with twelve measures for IHP + Development Partners and ten for IHP + recipient country governments. Data were collected through self-administered survey tools. IHP+Results analyzed these data, using transparent criteria, to produce Scorecards as a means to highlight progress against commitments and thereby strengthen mutual accountability amongst IHP + signatories. RESULTS: There have been incremental improvements in the strengthening of national planning processes and principles around mutual accountability. There has also been progress in Development Partners aligning their support with national budgets. But there is a lack of progress in the use of countries' financial management and procurement systems, and in the integration of duplicative performance reporting frameworks and information systems. DISCUSSION AND CONCLUSIONS: External, independent monitoring is potentially useful for strengthening accountability in health sector aid. While progress in strengthening country ownership, harmonisation and alignment seems evident, there are ongoing challenges. In spite of some useful findings, there are limitations with IHP + monitoring that need to be addressed. This is not surprising given the challenge of rigorously monitoring Development Partners across multiple recipient countries within complex global systems. The findings presented here suggest that the health sector is ahead of the game--in terms of having an established mechanism to promote alignment and harmonisation, and a relatively advanced monitoring framework and methods. But to capitalise on this, IHP + signatories should: a) reaffirm their commitments to the IHP+; b) actively embrace and participate in monitoring and evaluation processes; and c) strengthen in-country capacity notably amongst civil society organizations.