Which Policy to Which Family? The Answers to New Social Risks in Three Welfare Systems

Radical employment, household structure and stability transformations have created new tensions on the welfare state front, whose social programs were constructed in an era with a wholly different risk profile. Rowntree's poverty cycle clearly exemplifies the postwar picture of an exceptional low risk of economic deprivation in the active phase of life cycle, due to decisive factors as well-functioning, full-employment labor markets and stable and fertile families. Since 1970s, because of the increasing family instability and the rising structural unemployment and inequality in wages and incomes, western welfare states have found their safety nets straining under the burden of expanding number of working age families. Market and family concomitant 'failure' is a major catalyst of poverty and the risk of social exclusion and economic insecurity entrapment are considerable. Here, however, welfare states' design make a difference, to the extent that it has rethought traditional assumption on work, family and social risks. The key issue, we find, is in the readiness or reluctance to create, through government, a foundation of income or to supplement earned income or other benefits to families and their successful performance in the labor market. I concentrate on three western settings, each characterized by strong diversities in the resource distribution systems (family, labor market and welfare) and by a different level of economic deprivation: Italy, Sweden and the United States. They nonetheless identify ideal-typical representations of Esping-Andersen's conservative, social-democratic and liberal regimes, respectively (Esping-Andersen, 1990)

Técnicas para aumento de disponibilidade de Conversores de Frequência de Média Tensão Topologia CHBI no acionamento de BCSS.

Métodos de elevação artificial são corriqueiramente empregados na indústria de petróleo com objetivo de fornecer a energia necessária para que o fluído seja transferido do reservatório até a superfície, de maneira a ser processado nas unidades de produção. O Sistema BCSS é um método de elevação artificial bastante utilizado na indústria do petróleo, aplicado principalmente em campos maduros e campos com óleo pesados (baixo grau API), onde a energia é fornecida ao fluído através do acionamento elétrico de um conjunto moto bomba submerso, realizado por um conversor de frequência de média tensão disposto na superfície. Os sistemas elétricos presentes nas unidades de produção de petróleo de maneira geral priorizam a existência de redundância das cargas elétricas, essencialmente as relacionadas à segurança operacional e produção, de modo a aumentar a confiabilidade do sistema. Porém, no caso de sistemas BCSS, a alimentação de cada poço depende da operacionalidade de um conversor de frequência dedicado, sendo que a redundância fica praticamente impossibilitada devido às dimensões dos equipamentos dispostos nas plataformas de produção. Devido ao alto custo das intervenções para substituição dos conjuntos BCSS, é esperado deste sistema o máximo de disponibilidade possível. Existe uma tendência pela construção de poços com vazões cada vez maiores, e que consequentemente demandam equipamentos de potências cada vez mais altas. Desta forma, a confiabilidade dos conversores de frequência aplicados para este fim torna-se essencialmente importante para a operação deste sistema, uma vez que uma falha no conversor se traduz diretamente em perda de produção daquele poço e parada do conjunto BCSS associado. O objetivo deste trabalho é analisar os conversores de frequência de média tensão que utilizam a topologia PWM multinível no acionamento de conjuntos BCSS sob o ponto de vista de confiabilidade e disponibilidade, propondo técnicas para aumento da disponibilidade do conversor de frequência de média tensão na topologia multinível, com foco no aumento da disponibilidade do sistema BCSS ao longo da vida útil de um poço de petróleo, de modo a obter menores perdas de produção e um melhor retorno econômico sobre o investimento

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.</p> <p>Methods</p> <p>The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.</p> <p>Results</p> <p>The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.</p> <p>Conclusion</p> <p>Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

Embedding implementation research to strengthen efforts towards improving primary health care in resource limited settings

Immunization reaches more people than any other health service and it is a vital component of primary health care (PHC) (1,2). The Immunization Agenda 2030 emphasizes building strong national immunization programs integrated into primary health care services as the basis for achieving high vaccination coverage (2). In Ethiopia, immunization services are the backbone of PHC and are delivered in all public health facilities across the country (1). Even though the national EPI target is to reach a coverage of 90%(1), achieving and maintaining high immunization coverage is challenged by multifaceted demand and supply side implementation barriers (3–5). These barriers are related to community engagement, immunization service delivery, supply chain management, and surveillance and data management of the immunization program (5). Consequently, the national full vaccination coverage stalled at 43% (6)

A holistic and integrated approach to implementing cognitive pharmaceutical services

La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentrasometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidorescomo de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su prácticahacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estosservicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en susdefiniciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellospueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisionesclínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión estánrelacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a laspolíticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes delcambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y lainvestigación en práctica farmacéutica que se ha venido realizando con anterioridad han sidosintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamientoholístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puedeenmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organizaciónprofesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con laimplantación de servicios ha mostrado la aplicación de programas de implantación que han incluidouno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrolladoun modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado yholístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) quepretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, elservicio de seguimiento farmacoterapéutico.Community pharmacy is part of the health care system which is currently under economic pressureand facing changes in demands from consumers and government. In response, the pharmacy profession is becoming more patient orientated and implementing cognitive pharmaceutical services(CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels andusing different tools. However, they can be classified using a broad hierarchical model based onclinical decision making and the extent of change required (Box 1). The challenges faced by theprofession are related the development of a new patient orientated model of pharmacy which affectshealth care policy, education and research, the evolution of the market, the individual andorganisational approaches to change and the implementation of CPS. These issues and previousresearch conducted in pharmacy practice have been synthesised to provide a platform for change thatcan guide a holistic and integrated approach to CPS implementation. Implementation can beconceptually framed in six levels: clinical, service provision, community pharmacy, professionalorganisation, government and stakeholder (Figure 1). Past experience with service implementation hasseen the application of programs that include one or two of these levels in practice rather than aholistic approach. A concentric model was developed to illustrate the implementation of CPS and theholistic and integrated approach required to support change. A program (conSIGUE) being conductedin Spain has attempted to integrate all six levels to support the implementation and evaluation of amedication management service (Seguimiento Farmacoterapéutico

Un enfoque holístico e integrado de la implantación de los servicios farmacéutico cognitivos

Community pharmacy is part of the health care system which is currently under economic pressure and facing changes in demands from consumers and government. In response, the pharmacy profession is becoming more patient orientated and implementing cognitive pharmaceutical services (CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels and using different tools. However, they can be classified using a broad hierarchical model based on clinical decision making and the extent of change required (Box 1). The challenges faced by the profession are related the development of a new patient orientated model of pharmacy which affects health care policy, education and research, the evolution of the market, the individual and organisational approaches to change and the implementation of CPS. These issues and previous research conducted in pharmacy practice have been synthesised to provide a platform for change that can guide a holistic and integrated approach to CPS implementation. Implementation can be conceptually framed in six levels: clinical, service provision, community pharmacy, professional organisation, government and stakeholder (Figure 1). Past experience with service implementation has seen the application of programs that include one or two of these levels in practice rather than a holistic approach. A concentric model was developed to illustrate the implementation of CPS and the holistic and integrated approach required to support change. A program (conSIGUE) being conducted in Spain has attempted to integrate all six levels to support the implementation and evaluation of a medication management service (Seguimiento Farmacoterapéutico)La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentra sometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidores como de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su práctica hacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estos servicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en sus definiciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellos pueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisiones clínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión están relacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a las políticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes del cambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y la investigación en práctica farmacéutica que se ha venido realizando con anterioridad han sido sintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamiento holístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puede enmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organización profesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con la implantación de servicios ha mostrado la aplicación de programas de implantación que han incluido uno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrollado un modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado y holístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) que pretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, el servicio de seguimiento farmacoterapéutico

The Implementation of Social and Behavior Change Communication Intervention to Improve Immunization Demand: A qualitative study in Awabel District, Northwest Ethiopia

AbstractBackground: Immunization coverage in Ethiopia is low, and dropout rates are high. Social Behavior Change Communication (SBCC) interventions were introduced as a means of combating the ‘demand-side’ immunization barriers. However, Little research exists in terms of the efficacy of the SBCC intervention, in terms of promoting uptake, and improving the immunization demands in Ethiopia.Aim: To explore the current implementation status, and perceived effectiveness of SBCC intervention, barriers and facilitators with new strategies aimed at effective implementation of the SBCC intervention in Awabel District, Northwest Ethiopia.Methods: A phenomenological qualitative study was conducted from January 1- October 31, 2020. In-dept interviews were conducted with fifteen key-informants using a piloted semi-structured interview guide. Participants were purposively selected, which comprised of mangers, Expanded Program of Immunization (EPI) focal personnel, Health Extension Workers (HEWs), Women Development Armies (WDAs), mothers and community representatives. Six vaccination sessions were observed. Coding was done to identify patterns. Thematic analysis was performed using Open Code 4. 02.Results: Interpersonal communication, community conversation, social mobilization and family modeling were used as SBCC approaches. HEWs were the key source of information. Religious leaders were among the major stakeholders that encourage immunization. SBCC was perceived as an effective measure to improve immunization demand. There were multiple barriers for implementation of SBCC interventions including limited resources, lack of awareness, geographic barriers, traditional beliefs, lack of incentives, and limited EPI staff and health facility operating hours. Engagement of fathers and religious leaders, strengthening the WDA, and allocation of more resources were listed as possible strategies to tackle barriers.Conclusion: The implementation of SBCC interventions is important to improve immunization demand. Despite its effectiveness, there are several multi-level barriers to its successful implementation. Further, greater investments are required to improve infrastructures, staff employment and capacity building. [Ethiop. J. Health Dev. 2021; 35(SI-3):49-55]Keywords: Immunization, SBCC, Ethiopi

Strategies to revitalize immunization service provision in urban settings of Ethiopia

AbstractBackground: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopi

The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion