Large-scale rollout of extension training in Bangladesh: Challenges and opportunities for gender-inclusive participation.
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ABSTRACT:
SUBMITTER: Medendorp JW
PROVIDER: S-EPMC9269913 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with 'mobile health' (mhealth) being a key component of this. However, while 'formal' (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers' (CHWs') 'informal mhealth' practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of 'formal' compared with 'informal' mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this 'informal health' usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
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Project description:Among the different thermo-chemical recycling routes for plastic waste valorization, gasification is one of the most promising, converting plastic waste into syngas (H2+CO) and energy in the presence of an oxygen-rich gas. Plastic waste gasification is associated with many different complexities due to the multi-scale nature of the process, the feedstock complexity (mixed polyolefins with different contaminations), intricate reaction mechanisms, plastic properties (melting behavior and molecular weight distribution), and complex transport phenomena in a multi-phase flow system. Hence, creating a reliable model calls for an extensive understanding of the phenomena at all scales, and more advanced modeling approaches than those applied today are required. Indeed, modeling of plastic waste gasification (PWG) is still in its infancy today. Our review paper shows that the thermophysical properties are rarely properly defined. Challenges in this regard together with possible methodologies to decently define these properties have been elaborated. The complexities regarding the kinetic modeling of gasification are numerous, compared to, e.g., plastic waste pyrolysis, or coal and biomass gasification, which are elaborated in this work along with the possible solutions to overcome them. Moreover, transport limitations and phase transformations, which affect the apparent kinetics of the process, are not usually considered, while it is demonstrated in this review that they are crucial in the robust prediction of the outcome. Hence, possible approaches in implementing available models to consider these limitations are suggested. Finally, the reactor-scale phenomena of PWG, which are more intricate than the similar processes-due to the presence of molten plastic-are usually simplified to the gas-solid systems, which can result in unreliable modeling frameworks. In this regard, an opportunity lies in the increased computational power that helps improve the model's precision and allows us to include those complexities within the multi-scale PWG modeling. Using the more accurate modeling methodologies in combination with multi-scale modeling approaches will, in a decade, allow us to perform a rigorous optimization of the PWG process, improve existing and develop new gasifiers, and avoid fouling issues caused by tar.
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Project description:BACKGROUND:Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1-5?years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the influence of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women's outcomes. METHODS:Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender outcomes were analysed using FHI 360's Gender Integration Framework. RESULTS:The Anchal program was found to be a gender accommodating program as it catered for communities' gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender affected program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability. CONCLUSIONS:The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.
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Project description:The emergence of the "4th Industrial Revolution," i.e. the convergence of artificial intelligence, the Internet of Things, advanced materials, and bioengineering technologies, could accelerate socioeconomic insecurities and anxieties or provide beneficial alternatives to the status quo. In the post-Covid-19 era, the entities that are best positioned to capitalize on these innovations are large firms, which use digital platforms and big data to orchestrate vast ecosystems of users and extract market share across industry sectors. Nonetheless, these technologies also have the potential to democratize ownership, broaden political-economic participation, and reduce environmental harms. We articulate the potential sociotechnical pathways in this high-stakes crossroads by analyzing cellular agriculture, an exemplary 4th Industrial Revolution technology that synergizes computer science, biopharma, tissue engineering, and food science to grow cultured meat, dairy, and egg products from cultured cells and/or genetically modified yeast. Our exploration of this space involved multi-sited ethnographic research in both (a) the cellular agriculture community and (b) alternative economic organizations devoted to open source licensing, member-owned cooperatives, social financing, and platform business models. Upon discussing how these latter approaches could potentially facilitate alternative sociotechnical pathways in cellular agriculture, we reflect upon the broader implications of this work with respect to the 4th Industrial Revolution and the enduring need for public policy reform.
| S-EPMC8383920 | biostudies-literature
Project description:ObjectiveGender norms shape individuals' perceptions and behaviours, particularly concerning health outcomes. However, the lack of comprehensive gender norm attitude measures in low- and middle-income countries, including Bangladesh, impedes gender-transformative efforts. This study introduces the Multidomain Gender Norm Attitude Scale (M-GNAS) to evaluate gender norm attitudes among Bangladeshi youths.MethodThree sequential studies were conducted in Bangladesh in 2022 to develop the M-GNAS. Study 1 engaged 124 participants in focus group discussions, generating a 40-item pool reflecting prevalent gender norms. Study 2 involved 1374 youths (mean age 26.82, SD 5.50) to finalise the M-GNAS items and explore its latent structure through exploratory factor analysis (EFA). Study 3, with 1416 participants of similar age, used confirmatory factor analysis (CFA) to assess structural validity and structural equation modelling to evaluate measurement invariance (MI) across genders.ResultsEFA identified a four-domain solution with 13 items: gender-appropriate behaviour, family financial decisions, family responsibility, and career choice. CFA supported this four-domain solution (CFI=0.96, TLI=0.95; RMSEA=0.07; SRMR=0.04). MI across gender was well established (CFI & TLI>0.95, RMSEA≤0.06, SRMR<0.6). Higher education was associated with more egalitarian attitudes (F (5, 1408) = 7.25, p < 0.001), supporting the scale's construct validity.ConclusionThe M-GNAS is a psychometrically robust tool for assessing youths' attitudes toward prevalent gender norm domains in Bangladesh. It holds the potential for contributing to gender-transformative programmes and could be applied in similar initiatives across developing nations, contingent upon appropriate validation.
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Project description:This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
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Project description:Background: In 2018, Stellenbosch University's Ukwanda Centre for Rural Health led a faculty initiative to expand undergraduate health professions training to a new site, 9 hours drive from the health sciences campus in the sparsely populated Northern Cape Province of South Africa in the town of Upington. This is part of a faculty strategy to extend undergraduate health sciences training into an under-resourced part of the country, where there is no medical school. During 2019, the first year of implementation, four final year medical students undertook a longitudinal integrated clerkship at this site, while final year students from other programmes undertook short 5-week rotations, with plans for extending rotations and including more disciplines in 2020. The aim of this study was to understand stakeholder perceptions regarding the development of Upington as a rural clinical training site and how this influenced existing services, workforce sustainability and health professions education. Methods: An iterative thematic analysis of qualitative data collected from 55 participants between January and November 2019 was conducted as part of the case study. A constructivist approach to data collection was utilized to explore participants' perceptions, experiences and understanding of the new training site. Triangulation of data collection and reflexive thematic analysis contributed to the trustworthiness of the data and credibility of the findings. Findings: The perceptions of three key groups of stakeholders are reported: (1) Dr. Harry Surtie Hospital and Academic Programme Managers; (2) Supervising and non-supervising clinical staff and (3) Students from three undergraduate programs of the Faculty. Five themes emerged regarding the development of the site. The themes include the process of development; the influence on the health service; workforce sustainability; a change in perspective and equipping a future workforce. Discussion: This case study provides data to support the value of establishing a rural clinical training platform in a resource constrained environment. The influence of the expansion initiative on the current workforce speaks to the potential for improved capacity and competence in patient management with an impact on encouraging a rural oriented workforce. Using this case study to explore how the establishment of a new rural clinical training site is perceived to influence rural workforce sustainability and pathways, may have relevance to other institutions in similar settings. The degree of sustainability of the clinical training initiative is explored.
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Project description:Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non-governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.
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Project description:National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy.FAST was implemented sequentially at three hospitals.Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding.FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.
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Project description:Boosting the number of women and girls entering careers involving STEM (Science, Technology, Engineering and Maths) is crucial to achieving gender equality, one of the UN Sustainable Development Goals. Girls and women tend to gravitate away from STEM fields at multiple stages from childhood through mid-career. The leaky pipeline is a metaphor often used to describe the loss of women in STEM and arguably other fields before reaching senior roles. Do interests expressed on social media mirror the leaky pipeline phenomenon? In this article, we collected advertisement data (reach estimates) from Facebook and Instagram disaggregated by US metros, age, gender, and interests related to STEM. We computed the Gender Gap Index (GGI) for each US metro and age group. We found that on Instagram, the GGIs for interest in Science decrease as users' age increases, suggesting that relatively there is evidence that that women, compared to men, are losing interest in STEM at older ages. In particular, we find that on Instagram, there are plausible relative trends but implausible absolute levels. Nevertheless, is this enough to conclude that online data available from Instagram mirror the leaky pipeline phenomenon? To scrutinize this, we compared the GGIs for an interest in Science with the GGIs for placebo interests unrelated to STEM. We found that the GGIs for placebo interests follow similar age patterns as the GGIs for the interest in Science across US metros. Second, we attempted to control for the time spent on the platform by computing a usage intensity gender ratio based on the difference between daily and monthly active users. This analysis showed that the usage intensity gender ratio is higher among teenagers (13-17 years) than other older age groups, suggesting that teenage girls are more engaged on the platform that teenage boys. We hypothesize that usage intensity differences, rather than inherent interest changes, might create the illusion of a leaky pipeline. Despite the previously demonstrated value and huge potential of social media advertisement data to study social phenomena, we conclude that there is little evidence that this novel data source can measure the decline in interest in STEM for young women in the USA.
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