A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda

BACKGROUND: Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. METHODS: This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. RESULTS: The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. CONCLUSIONS: Improved health manager capacity is essential if sustained improvements in health outcomes in lowincome countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity

Abrasive, Silica Phytoliths and the Evolution of Thick Molar Enamel in Primates, with Implications for the Diet of Paranthropus boisei

Background: Primates—including fossil species of apes and hominins—show variation in their degree of molar enamel thickness, a trait long thought to reflect a diet of hard or tough foods. The early hominins demonstrated molar enamel thickness of moderate to extreme degrees, which suggested to most researchers that they ate hard foods obtained on or near the ground, such as nuts, seeds, tubers, and roots. We propose an alternative hypothesis—that the amount of phytoliths in foods correlates with the evolution of thick molar enamel in primates, although this effect is constrained by a species ’ degree of folivory. Methodology/Principal Findings: From a combination of dietary data and evidence for the levels of phytoliths in plant families in the literature, we calculated the percentage of plant foods rich in phytoliths in the diets of twelve extant primates with wide variation in their molar enamel thickness. Additional dietary data from the literature provided the percentage of each primate’s diet made up of plants and of leaves. A statistical analysis of these variables showed that the amount of abrasive silica phytoliths in the diets of our sample primates correlated positively with the thickness of their molar enamel, constrained by the amount of leaves in their diet (R 2 = 0.875; p,.0006). Conclusions/Significance: The need to resist abrasion from phytoliths appears to be a key selective force behind the evolution of thick molar enamel in primates. The extreme molar enamel thickness of the teeth of the East African homini

Position paper: The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques — which can provide minimally invasive or noninvasive alternatives to biopsy — could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care

Electron conduction associated with the chemical transport of reducing elements in oxide cathode for CRT's application

In the present work, the formation of compounds associated to the diffusion of reducing elements (Mg, Al and W) to the Ni cap surface of oxide cathode has been studied by a new method. This method used two cathodes, one of them is coated and the other is uncoated, to be in an attach-contact mounted in a dummy tube. Different analytical techniques were used for this study: scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX) and I/V electrical measurements. After oxide cathode plus decomposited and activated, Al and Mg doping elements take place during heating to 810 degrees C (Ni-Br) under a rich controlled Ba/SrO atmosphere through an acceleration life test. It is shown that the chemical transport occurs mainly by a grain boundary mechanism with significant pile-up of Mg compounds. Al and W show a superficial concentrations and distribution. The dc electrical characteristic shows very strong rectifying behaviour through the M-S junction due to the I/V curves, particularly after 144 h acceleration life time. The characteristics are found to be reversible and reproducible, and viewed a rectification ratio (r) of 100. The calculated ideality factor shows a value of n = 9.6, which is evidenced to the tunnelling conduction. The theoretical calculation shows that the interface thickness grows to (similar to 6 mu m) after accelerated the cathode to 1896 h. (c) 2005 Elsevier B.V. All rights reserved

'Joined up' policy making : group decision and negotiation practice

Creating public value is problematic in a world of austerity. Joint private and public, and public-public, projects are now an established way of creating public value. Establishing joint goals within a context of different ‘own goals’ is important and difficult. A particular issue facing many organisations in seeking to negotiate joint goals in a collaborative project is that of getting all the key managers from both organisations together over enough of a sequence of meetings for agreements to be meaningful and owned by those who will deliver the project. The development of such goals can be significantly enhanced by i) using a Group Decision Support System (GDSS) and ii) using a powerful conceptualisation of a goals framework comprising: a goals system; ‘core goals’; ‘meta-goals’; ‘negative’ goals; and ‘above and beyond’ goals. In the case of negotiating joint goals the use of a GDSS has increased productivity to such an extent that powerful negotiated agreements can be achieved with all key managers in the room in as little as one meeting. The combination of high productivity, anonymity, and the structuring of the data has also facilitated the uncovering of ‘negative goals’, and the development of ‘meta-goals’ and ‘above and beyond’ goals. This paper uses three real cases to illustrate the significance of a Group Support System’s contribution and to illustrate the different types of goals. In doing so the paper suggests that facilitating such outcomes requires a carefully designed strategic conversation necessarily supported by a Group Decision Support System to enable group decision and negotiation in practice. Two of the cases are from public-public collaboration in the health field, and the other from a private-public setting