Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies

Towards an Economy of Higher Education

This paper draws a distinction between ways thinking and acting, and hence of policy and practice in higher education, in terms of different kinds of economy: economies of exchange and economies of excess. Crucial features of economies of exchange are outlined and their presence in prevailing conceptions of teaching and learning is illustrated. These are contrasted with other possible forms of practice, which in turn bring to light the nature of an economy of excess. In more philosophical terms, and to expand on the picture, economies of excess are elaborated with reference, first, to the understanding of alterity in the work of Emmanuel Levinas and, second, to the idea of Dionysian intensity that is to be found in Nietzsche. In the light of critical comment on some current directions in policy and practice, the implications of these ways of thinking for the administrator, the teacher and the student in higher education are explored

Political risk and foreign direct investment in Africa: the case of the Nigerian telecommunications industry

Foreign direct investment (FDI) flows are expected to be influenced by political risk factors. However, studies that evaluate the relationship between political risk and FDI flows in Sub-Saharan Africa (SSA) are scarce. This study examines the impact of political risk on FDI flows in a SSA context using the 12 political risk components published as the International Country Risk Guide (ICRG) by the Political Risk Services Group (PRS) with the Nigerian telecommunications sector as a case study. The study finds that political risk has a significant influence on the inflow of FDI into developing economies in SSA such as Nigeria and that the 12 components affect FDI in different ways. Irrespective of the political risk rating, a consistent improvement in composite political risk enhances FDI inflow. Among the 12 components, corruption, law and order, democratic accountability and investment profile were found to have significant influences on FDI inflow into the Nigerian telecommunications sector. Corruption, in particular, explains nearly two-thirds of the FDI inflow

The impact of climate-related extreme events on public health workforce and infrastructure – how can we be better prepared?

The Intergovernmental Panel on Climate Change’s fifth assessment report1 states with confidence that human induced climate change is occurring and that temperatures will continue to rise, even if CO2 emissions were to stop forthwith. The report also acknowledges that climate-related extreme events are increasing in frequency, severity and duration; particularly heavy rainfall events, intensification of cyclones, increases in tidal surge and fires. This poses the question: “Are we prepared?” This is question that public health authorities will need to face but, as health systems are increasingly stressed due to limited resources, increased demand and workforce shortages, being prepared becomes even more challenging. Extreme events place an additional burden on health systems already under pressure due to increased demand for health care services, and as public health resources are offset against the demands in the acute care sector. (For the purposes of this paper, public health services refer to those health and related services that seek to prevent disease and promote health.) The impact on often already overstretched public health services may not be recognised, and additional resourcing and support may not follow. As discussed later, recent Australian experiences indicate that the status quo will not be sufficient to both mount a successful public health response to climate-related extreme events and maintain a strong public health infrastructure

Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh

<p>Abstract</p> <p>Introduction</p> <p>Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities.</p> <p>Case description</p> <p>Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles.</p> <p>Discussion and Evaluation</p> <p>A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor.</p> <p>Conclusions</p> <p>Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.</p

Legal Empowerment and Horizontal Inequalities after Conflict

This article explores whether legal empowerment can address horizontal inequalities in post-conflict settings, and, if so, how. It argues that legal empowerment has modest potential to reduce these inequalities. Nevertheless, there are risks that legal empowerment might contribute to a strengthening of group identities, reduction of social cohesion, and, in the worst case, triggering of conflict. It looks at how two legal empowerment programmes in Liberia navigated the tensions between equity and peace

Increase in computed tomography in Australia driven mainly by practice change: A decomposition analysis

Background: Publicly funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia. Methods: A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3. Results: The number of billed CT scans rose from 33 per annum per 1000 of population in 1993/94 (total 572,925) to 112 per 1000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to$790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period. Conclusions: While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This ‘scope shift’ poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used

Children’s use of public spaces and the role of the adult – a comparison of play ranging in the UK, and the leikkipuisto (Play Parks) in Finland

This paper compares the use of public space in the UK and Finland (Leikkipuisto). This is considered with regards to Playranging in the UK and the Ohjaaja in Finlan

Assessment of solar shading strategies in low-income tropical housing: the case of Uganda

Developing countries in tropical and subtropical areas will be the worst hit by climate change. Very little research has been done to assess the impact of climate change on thermal comfort in low-income housing in these regions. The effects of solar shading strategies and solar absorptance properties of walls and roofs on thermal comfort in Ugandan low-income housing are studied in this paper. Various shading strategies including curtains, roof and window overhangs, veranda and trees as well as effects of painting on solar heat gain and thermal comfort are modelled using EnergyPlus software. An adaptive approach for naturally ventilated buildings defined by the European Committee for Standardization standard BS EN 15251:2007 is used to assess the conditions. According to the results, solar shading is less effective in meeting thermal comfort requirements and it should be used in conjunction with other strategies to achieve desirable results. White painting, in contrast, significantly improved the conditions and significantly reduced the risk of overheating. Solar shading proved to be effective during the hottest periods of the year, reducing the risk of extreme overheating by up to 52%

Independent advocacy for children and young people: developing an outcomes framework

Advocacy services for vulnerable children and young people began to be provided in the 1980s (Willow, 2013) and have grown as legislation and guidance expanded the range and remit of services (Wood and Selwyn, 2013). Research has followed the development of policy and services, but until recently has not examined the impact and outcomes of advocacy in any depth. In this article we draw on findings from a study of the outcomes and impact of independent advocacy for children and young people to explore how the value of advocacy is understood by them and by advocates, social workers and other professionals, and to consider what differences advocacy can make to the lives of children and young people (Thomas et al., 2016). Our findings indicate that the outcomes of advocacy in children and young people’s lives can be significant and wide-ranging, including both direct effects on the child or young person and wider impact on services. This complex picture has implications for how best to capture and report the outcomes of advocacy, which we explore in the latter part of the article with the aid of a proposed new conceptual framework