Pull and Push: Strengthening Demand for Innovation in Education

Examines policy, information, and cultural barriers that minimize the "demand pull" for educational innovation. Calls for encouraging early adopters, bolstering smart adoption, providing better information, and rewarding productivity improvements

PRIMUS/Informed Cities: Making research work for local sustainability

The final report of a three year European Commission FP7 project

Trend in revenue loss due to expired medication at a large urban hospital in Johannesburg, South Africa

A Research Report Submitted to the School of Public Health, University of the Witwatersrand in Partial Fulfilment of the Requirements for the Degree of Master of Public Health June 2016ntroduction Limited research has been conducted on the causes and economic impacts of expired medicine, yet medicine costs comprise a significant proportion of healthcare expenditure. Medicines and their management are an important health system function, necessary for improving and maintaining health. However the lack and wastage of essential medicine is still one of the most serious public health problems globally, including South Africa. The high rate of medicine expiry highlights a problem throughout the supply chain and this wastage reduces the quantity of medicines available to patients and therefore the quality of healthcare they receive. This study aimed to estimate the revenue loss due to expired medicines within a hospital setting from January 2011 to June 2014 and explore reasons for this. Methods This mixed methods study is a retrospective analysis review of forty-two months of expired medicine reports extracted at a public sector hospital coupled with a qualitative exploration (through semi-structured in-depth interviews) with key stakeholders about possible reasons for the expiration of medicines. In addition, informal observations were conducted across the duration of the fieldwork and recorded in a researcher diary. Ethics and research approvals for the study were obtained from the University of Witwatersrand Human Ethics Committee and the hospital. Results 32,368 medicines had expired over the study period. These data were drawn from the wards, outpatient departments and pharmacy and consisted of 68 different Anatomical Therapeutic Chemical (ATC) classes. More than 80% of the expired medicines were on the essential medicine list (EML) with antibacterial for systemic use (16%, n=5067) and antivirals for systemic use (15%, n=4970) among the highest classes that expired. The estimated total value of expired medicine for the study period was R838 029; an estimated annual revenue loss of 0.6% of the hospital’s total pharmaceutical expenditure; and an average increase in percentage revenue loss of 72% for the study period. Two main themes emerged from the in-depth interviews conducted with key stakeholders; i) Knowledge, understanding and practical application of policies and procedures related to expired medicines, and ii) Diversion from Ideal: procedures and constraints which may impact implementation. A closer examination to explore the reasons for these diversions - the ‘whys’- revealed three thematic areas: mistrust among employees and in the system, fear of being ‘caught’ yet lack of accountability and, ineffective communication and coordination. Discussion Expiry of medicines was highest among essential medicine on the supply-side. Medicines management is not restricted to pharmacists and although adequate tools for quantification and demand planning exist, none of these are focused on the health worker who has no formal training in medicine supply management. The study highlighted the need to identify effective strategies for phasing in and out of pharmaceutical policies and tenders to minimize waste. There is a lack of standard treatment guideline knowledge among prescribers. The extent of expired medicines at patients’ homes, patient returns or cost of disposing off expired medicine were not analysed. The relationship between governing documents and daily practices are not well understood by those responsible for managing medicines and accountability is not clearly assigned. Recommendations and Conclusion Creating awareness about the risk of medicines expiring and cost impact on service delivery should be communicated to healthcare workers and policy makers. Medicine supply management should be included as part of job descriptions of employees who manage medicines at this hospital to enhance accountability. Employing clinical pharmacists in the wards at tertiary hospitals may improve medicine management. Continuous monitoring and periodic evaluations to identify and address challenges related to medicine wastage is paramount to reduce financial loss and improve health outcomes. Sound coordination and communication is needed between the pharmacy and other departments in the hospital. Additionally, Pharmaceutical and Therapeutics Committees should emphasise the use of Standard Treatment Guidelines.MB201

Scotland Chikwawa Health Initiative - improving health from community to hospital

The Scotland Chikwawa Health Initiative is a three year programme funded by the Scottish Executive International Development Fund which aims to achieve measurable reductions in major causes of disease and death in four villages within the Chikwawa District of Malawi alongside improving the hospital environment for the good of both staff and patients. The initiative has developed a holistic approach to health improvements through the provision of infrastructure at both health facilities and within communities, and training of government personnel and community volunteers. Specific areas targeted have included water and sanitation, maternal health, and communicable disease control with provision of training and materials to facilitate interventions and health education. At the end of the second year the programme has already seen reductions in diarrhoeal disease (30% overall in target communities), improved access to safe water, an increase in the uptake of growth monitoring and immunisations in children under the age of five years (15% increase since training volunteers), improved safe delivery of babies within the community (245 babies delivered safely in target communities with 25 referred due to complications) and increased community health activity (training and integration of village health committees, water point committees, traditional birthing attendants and health surveillance assistants). The programme hopes to act as a model for the District to follow in other communities to achieve it’s obligations under the Malawi Ministry of Health Essential Health Package

Epidemiology of cryptosporidiosis in rural Malawi

A hospital and community based study was conducted in Malawi, within a rural population over a 23 month period, to identify the incidence, causative species and possible determinants for cryptosporidiosis in under fives. 5.9% (25/423) of samples collected were positive for Cryptosporidium oocysts of which 18 amplified by PCR-RFLP indicating the following species: C. hominis, C. parvum, C. meleagridis and C. andersoni. Consenting positive cases were included in a case control study. 96 home interviews were conducted in 24 communities (cases n=24; unmatched controls n=72). A total of 61 risk factors were investigated with a questionnaire, and combined with quantitative data from samples of domesticated animal stools and drinking water. Oocysts were not isolated from domesticated animals or water samples. Multivariate logistic regression of questionnaire data revealed an increased risk of cryptosporidiosis associated with ownership of pigs (OR 7.2, 95%CI 1.9–27.5, p=0.004), presence of diarrhoea in the household (OR 8.8, 95%CI 1.8–53.4, p=0.008), bathing in the river (OR 76.7, 95%CI 1.1–23.8, p=0.037) and no education within the household (OR 3.6, 95%CI 1.1–11.8, p=0.038). Bacteriological results indicating faecal contamination of both drinking water stored within the home (76%), and the surface of guardians’ hands (75%) were indicative of poor hygienic practices and potential sources of infection

Ecological sanitation - Implementation, opportunities and challenges in Chikwawa

Ecological sanitation (EcoSan) in not a new technology but rather a recognition that human excreta is a valuable natural resource (not a waste to be disposed of), containing plant nutrients which after containment and sanitization can be recycled in agriculture to enhance food production, with minimal risk of pollution of the environment and with minimal threat to human health. Various organizations are implementing EcoSan technologies in Malawi. Chikwawa is a rural district that is currently implementing EcoSan initiatives with resources from the Scotland Chikwawa Health Initiative and the US Ambassador’s Self Help Fund. The benefits from EcoSan are clear. For example, EcoSan systems help reduce the risk of spreading diseases by containing and treating human excreta before collecting it; minimising surface and groundwater contamination and recylcing the nutrients found in excreta and returning them to soil to enhance food production. However, EcoSan poses some challenges in its implementation such as a correct utilization, acceptability and sustainability of the concept

Identifying Traffic Safety Practices and Needs of Local Transportation and Law Enforcement Agencies

As part of the effort to implement the Strategic Highway Safety Plan (SHSP), state departments of transportation are looking to reach out to local and law enforcement agencies. This paper presents a study by the Florida Department of Transportation (FDOT) to identify the existing safety practices and needs of local transportation agencies and law enforcement offices in Florida. Two comprehensive online surveys targeting local transportation agencies and law enforcement agencies are developed. The survey for local transportation agencies includes 39 questions on topics including standardization of crash analysis methods, training needs, and working with FDOT. For law enforcement agencies, the survey includes 25 questions covering topics on enforcement locations, traffic violations and safety campaigns, use of crash reports, and working with transportation agencies. Results from both surveys and lessons learned are discussed

Barriers to implementing asthma self-management in Malaysian primary care:qualitative study exploring the perspectives of healthcare professionals

Abstract Asthma self-management is a crucial component of asthma management. We sought to explore healthcare professionals’ (HCPs’) perceptions on barriers to asthma self-management implementation in primary care. We recruited 26 HCPs from six public primary care clinics in a semi-urban district of Malaysia in 2019. The analysis was done inductively. HCPs described barriers that resonated with the “COM-B” behaviour change framework. Capability-related issues stemmed from a need for specific self-management skills training. Opportunity-related barriers included the need to balance competing tasks and limited, poorly tailored resources. Motivation-related barriers included lack of awareness about self-management benefits, which was not prioritised in consultations with perceived lack of receptiveness from patients. These were compounded by contextual barriers of the healthcare organisation and multilingual society. The approach to implementation of asthma self-management needs to be comprehensive, addressing systemic, professional, and patient barriers and tailored to the local language, health literacy, and societal context

Data-Driven Accountability: Examining and Reorienting the Mythologies of Data

Indiana University-Purdue University Indianapolis (IUPUI)In this work, I examine and design sociotechnical interventions for addressing limitations around data-driven accountability, particularly focusing on politically contentious and systemic social issues (i.e., police accountability). While organizations across sectors of society are scrambling to adopt data-driven technologies and practices, there are epistemological and ethical concerns around how data use influences decisionmaking and actionability. My work explores how stakeholders adopt and handle the challenges around being data-driven, advocating for ways HCI can mitigate such challenges. In this dissertation, I highlight three case studies that focus on data-driven, human-services organizations, which work with at-risk and marginalized populations. First, I examine the tools and practices of nonprofit workers and how they experience the mythologies associated with data use in their work. Second, I investigate how police officers are adopting data-driven technologies and practices, which highlights the challenges police contend with in addressing social criticisms around police accountability and marginalization. Finally, I conducted a case study with multiple stakeholders around police accountability to understand how systemic biases and politically charged spaces perceive and utilize data, as well as to develop the design space around how alternative futures of being data-driven could support more robust and inclusive accountability. I examine how participants situate the concepts of power, bias, and truth in the data-driven practices and technologies used by and around the police. With this empirical work, I present insights that inform the HCI community at the intersection of data design, practice, and policies in addressing systemic social issues

Health Information Systems and Accountability in Kenya:a Structuration Theory Perspective

Health information systems (HIS) in most low- and middle-income countries (LMICs) have been often implemented under the international pressure of accounting for healthcare investments. The idea behind robust and efficient HIS is that health information can allow healthcare managers and providers to better plan and monitor health services, which may translate into better health outcomes. Yet, researchers have often criticized the use of HIS as accountability tools as being counterproductive by making health information more meaningful to national governments and international agencies than those in charge of local health services. In this paper, I analyze how HIS influence the emergence of local accountability practices and their consequences for healthcare provision. I build a theoretical perspective from structuration theory and integrate it with the technology domain of HIS. I use this perspective to analyze a case study of HIS in Kenya. This study raises implications for the use of structuration theory in understanding accountability and the role of IT materiality in processes of structuration. It contributes to a better understanding of how HIS can foster improved healthcare and human development. It also contributes to the understanding of IS as means not just for governing people’s behavior but also of socialization through which users can negotiate multiple accountability goals