Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions.

BACKGROUND: Preterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at 75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics

Implementing natural capital credit risk assessment in agricultural lending

Agriculture has critical impacts and dependencies on natural capital, and agriculturallenders are therefore exposed to natural capital credit risk through their loans tofarmers. Currently, however, lenders lack any detailed guidance for assessing naturalcapital credit risk in agriculture and are challenged by the fact that the relevant material risks vary considerably by agricultural sector and geography. This paper developsa natural capital credit risk assessment framework based on a bottom‐up review ofthe material risks associated with natural capital impacts and dependencies forAustralian beef production. It demonstrates that implementing natural capital creditrisk assessment is feasible in agricultural lending, using a combination of quantitativeand qualitative inputs. Implementation challenges include the complexity and interconnectedness of natural capital processes, data availability and cost, spatial data analytical capacity, and the need for transformational change, both within lendingorganisations and across the banking sector

Solidarities at a distance: extending Fairtrade gold to East Africa

This article examines how Fairtrade is transforming artisanal and small-scale gold mining. Focusing on the “Extending Fairtrade Gold to Africa” project in East Africa, it demonstrates how Fairtrade is becoming embedded within local formalization contexts and organizational dynamics. The Project is at an early stage; therefore, findings consider emerging issues. By probing what solidarities at a distance imply for gold mining, the article elaborates on how artisanal and small-scale miner organisations are developing to produce gold for Fairtrade markets. Whilst recognising that Fairtrade is not targeting the most marginalised, unlicensed miners, those groups incorporated into Fairtrade are heterogeneous and have significant development needs. With the ‘unfinished business’ of certification and supply of Fairtrade gold to international markets only starting to be realised, time is needed to tell whether an equitable distribution of benefits from Fairtrade will be realised amongst miners and within mining communities

Opportunity or necessity? Conceptualizing entrepreneurship at African small-scale mines

This article critically examines the policy environment in place for artisanal and small-scale mining (ASM) – low-tech, labour-intensive mineral extraction and processing – in sub-Saharan Africa, with a view to determining whether there is adequate ‘space’ for the sector's operators to flourish as entrepreneurs. In recent years, there has been growing attention paid to ASM in the region, particularly as a vehicle for stimulating local economic development. The work being planned under the Africa Mining Vision (AMV), a comprehensive policy agenda adopted by African heads of state in February 2009, could have an enormous impact on this front. One of its core objectives is to pressure host governments into Boosting Artisanal and Small-Scale Mining by following a series of streamlined recommendations. It is concluded, however, that there is a disconnect between how entrepreneurship in ASM has been interpreted and projected by proponents of the AMV on the one hand, and the form it has mostly taken in practice on the other hand. This gulf must be rapidly bridged if ASM is to have a transformative impact, economically, in the region. © 2017 Elsevier Inc