Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review

INTRODUCTION: There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS: A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as ‘PROGRESS-Plus’: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS: This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on “occupation” component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on “workers” such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to “worker focused” policy documents, most of the ‘whole population focused’ policy documents didn’t have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION: Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society

The workings of the single member plurality electoral system in India and the need for reform

India uses single member plurality system (SMPS) to elect the members of the lower house of its national parliament and the state assemblies. Under SMPS, elections are conducted for separate geographical areas, known as constituencies or districts, and the electors cast one vote each for a candidate with the winner being the candidate who gets the plurality of votes. SMPS is traditionally defended primarily on the grounds of simplicity and its tendency to produce winning candidates, which promotes a link between constituents and their representatives. It tends to provide a clear-cut choice for voters between two main parties, and is expected to gives rise to single-party rather than coalition governments. It also has the benefit of excluding extremist parties from gaining representation, unless their support is geographically concentrated

Child Mortality after Discharge from a Health Facility following Suspected Pneumonia, Meningitis or Septicaemia in Rural Gambia: A Cohort Study.

OBJECTIVE: To measure mortality and its risk factors among children discharged from a health centre in rural Gambia. METHODS: We conducted a cohort study between 12 May 2008 and 11 May 2012. Children aged 2-59 months, admitted with suspected pneumonia, sepsis, or meningitis after presenting to primary and secondary care facilities, were followed for 180 days after discharge. We developed models associating post-discharge mortality with clinical syndrome on admission and clinical risk factors. FINDINGS: One hundred and five of 3755 (2.8%) children died, 80% within 3 months of discharge. Among children aged 2-11 and 12-59 months, there were 30 and 29 deaths per 1000 children per 180 days respectively, compared to 11 and 5 respectively in the resident population. Children with suspected pneumonia unaccompanied by clinically severe malnutrition (CSM) had the lowest risk of post-discharge mortality. Mortality increased in children with suspected meningitis or septicaemia without CSM (hazard ratio [HR] 2.6 and 2.2 respectively). The risk of mortality greatly increased with CSM on admission: CSM with suspected pneumonia (HR 8.1; 95% confidence interval (CI) 4.4 to 15), suspected sepsis (HR 18.4; 95% CI 11.3 to 30), or suspected meningitis (HR 13.7; 95% CI 4.2 to 45). Independent associations with mortality were: mid-upper arm circumference (MUAC) of 11.5-13.0 cm compared to >13.0 cm (HR 7.2; 95% CI 3.0 to 17.0), MUAC 10.5-11.4 cm (HR 24; 95% CI 9.4 to 62), and MUAC <10.5 cm (HR 44; 95% CI 18 to 108), neck stiffness (HR 10.4; 95% CI 3.1 to 34.8), non-medical discharge (HR 4.7; 95% CI 2.0 to 10.9), dry season discharge (HR 2.0; 95% CI 1.2 to 3.3), while greater haemoglobin (HR 0.82; 0.73 to 0.91), axillary temperature (HR 0.71; 95% CI 0.58 to 0.87), and oxygen saturation (HR 0.96; 95% CI 0.93 to 0.99) were associated with reduced mortality. CONCLUSION: Gambian children experience increased mortality after discharge from primary and secondary care. Interventions should target both moderately and severely malnourished children

The Daemo crowdsourcing marketplace

The success of crowdsourcing markets is dependent on a strong foundation of trust between workers and requesters. In current marketplaces, workers and requesters are often unable to trust each other’s quality, and their mental models of tasks are misaligned due to ambiguous instructions or confusing edge cases. This breakdown of trust typically arises from (1) flawed reputation systems which do not accurately reflect worker and requester quality, and from (2) poorly designed tasks. In this demo, we present how Boomerang and Prototype Tasks, the fundamental building blocks of the Daemo crowdsourcing marketplace, help restore trust between workers and requesters. Daemo’s Boomerang reputation system incentivizes alignment between opinion and ratings by determining the likelihood that workers and requesters will work together in the future based on how they rate each other. Daemo’s Prototype tasks require that new tasks go through a feedback iteration phase with a small number of workers so that requesters can revise their instructions and task designs before launch

Prototype tasks: Improving crowdsourcing results through rapid, iterative task design

Low-quality results have been a long-standing problem on microtask crowdsourcing platforms, driving away requesters and justifying low wages for workers. To date, workers have been blamed for low-quality results: they are said to make as little effort as possible, do not pay attention to detail, and lack expertise. In this paper, we hypothesize that requesters may also be responsible for low-quality work: they launch unclear task designs that confuse even earnest workers, under-specify edge cases, and neglect to include examples. We introduce prototype tasks, a crowdsourcing strategy requiring all new task designs to launch a small number of sample tasks. Workers attempt these tasks and leave feedback, enabling the requester to iterate on the design before publishing it. We report a field experiment in which tasks that underwent prototype task iteration produced higher-quality work results than the original task designs. With this research, we suggest that a simple and rapid iteration cycle can improve crowd work, and we provide empirical evidence that requester “quality” directly impacts result quality

Co-opting the state: how weak parties can make stable party systems

Conventional understandings of party system institutionalisation assume that institutionalised parties are necessary for interparty competition to stabilise. However, this approach neglects the role of the state in shaping party competition. Using survey data from Bangladesh, India and Pakistan, it is shown that weakly institutionalised parties can lead to institutionalised party systems if parties are able to successfully co-opt the state and use state resources to supplement party deficiencies. By developing a relationship that intertwines parties with the state, parties in young democracies do not need to institutionalise for stable party systems to form

Crowd guilds: Worker-led reputation and feedback on crowdsourcing platforms

Crowd workers are distributed and decentralized. While decentralization is designed to utilize independent judgment to promote high-quality results, it paradoxically undercuts behaviors and institutions that are critical to high-quality work. Reputation is one central example: crowdsourcing systems depend on reputation scores from decentralized workers and requesters, but these scores are notoriously inflated and uninformative. In this paper, we draw inspiration from historical worker guilds (e.g., in the silk trade) to design and implement crowd guilds: centralized groups of crowd workers who collectively certify each other’s quality through double-blind peer assessment. A two-week field experiment compared crowd guilds to a traditional decentralized crowd work model. Crowd guilds produced reputation signals more strongly correlated with ground-truth worker quality than signals available on current crowd working platforms, and more accurate than in the traditional model

Boomerang: Rebounding the consequences of reputation feedback on crowdsourcing platforms

Paid crowdsourcing platforms suffer from low-quality workand unfair rejections, but paradoxically, most workers and requesters have high reputation scores. These inflated scores, which make high-quality work and workers difficult to find,stem from social pressure to avoid giving negative feedback. We introduce Boomerang, a reputation system for crowdsourcing that elicits more accurate feedback by rebounding the consequences of feedback directly back onto the person who gave it. With Boomerang, requesters find that their highly rated workers gain earliest access to their future tasks, and workers find tasks from their highly-rated requesters at the top of their task feed. Field experiments verify that Boomerang causes both workers and requesters to provide feedback that is more closely aligned with their private opinions. Inspired by a game-theoretic notion of incentive-compatibility, Boomerang opens opportunities for interaction design to incentivize honest reporting over strategic dishonesty