Antiretroviral treatment roll-out in Zambia and South Africa - a policy analysis to sub-national policy implementation processes

From 2002 international and national policies transformed the availability of antiretroviral medicines for people living with HIV/AIDS in Africa. By the end of 2008 an estimated 42 percent of people requiring such treatment were accessing medication and anti-retroviral treatment (ART) programmes had been rolled out in many countries (UNAIDS and WHO 2009). However, this expansion was implemented unevenly across and within different countries raising questions about the gap between policy intention and execution. This thesis addresses this gap. It examines the processes of implementation, comparing rapid ART roll-out in Zambia with South Africa where implementation was initially much slower. It draws on both top-down and bottom-up perspectives to better understand factors hindering and enabling implementation. The focus is on actors and their networks and how they were able to exert power on the implementation of policy. It is a qualitative study that relies on document review and over 150 interviews conducted with actors in the policy processes in both countries, during field work in 2007 and 2008. Findings confirmed the importance of communication, resources and structures in determining implementation, but the comparative analysis indicated their influence varied considerably according to context. The findings also offer new insights into how contrasting networks of actors affected implementation. A broad range of actors made it possible to roll-out ART in South Africa despite a hostile policy environment, by drawing on diverse sets of skills and ties that dated back to the anti-apartheid struggle. In Zambia the network which most influenced ART roll-out was an epistemic community of clinicians, which, by forging alliances with PEPFAR implementing agencies was able to rapidly scale up access to treatment in spite of health systems constraints. The economic capital of donors allowed them to shape policy and blur boundaries between state and non-state actors in Zambia while social capital of networks was important in South Africa. Findings suggest that focusing on the sources of power of networks in implementation enriches the understanding of health policy processes

The impact of agricultural input subsidies on food and nutrition security: a systematic review

Agricultural input subsidies, a form of social protection, are often considered an important means of improving agricultural productivity in low- and middle-income countries. However, their effectiveness and efficiency remains contentious with respect to productivity, economic and consumer welfare measures, as well as food and nutrition security. This is exacerbated by a weak evidence base, including no review focused on the impact of agricultural input subsidies on food security and nutrition. Further, where studies have considered nutritional outcomes of agricultural input subsidy interventions, this has often been in regard to changes in consumption of the targeted staple food, measured in terms of calorie consumption or a similar measure of changes in energy availability, ignoring other aspects of malnutrition, including impacts from dietary diversity. This wider consideration of impacts from dietary diversity is important, given the increasing recognition in nutrition policy of its importance. We address this gap in the literature with a review of the evidence on the impact of agricultural input subsidy programmes on nutrition and nutrition-related health in low- and middle-income countries, mapping this evidence against a conceptual framework of the mediating pathways

Hydrogen bond networks facilitate the conversion of aliphatic aldehydes in the charged active site of S. cerevisiae transketolase

Naturally, transketolase (TK, E.C. 2.2.1.1) catalyzes asymmetric C-C bond formation in glycolysis derived metabolites to afford carbohydrates for nucleotide synthesis and the production of essential aromatic amino acids.[1] While results obtained earlier in our group showed that a decrease in active site polarity in S. cerevisiae transketolase was beneficial for the conversion of non-phosphorylated substrates,[2] the charged mutation D469E was counterintuitively found to promote the conversion of aliphatic aldehydes in E. coli transketolase.[3] Here we present a comparative study of the most beneficial single and double point mutants obtained from both reports for the conversion of aliphatic aldehydes using S. cerevisiae transketolase.[4] It was confirmed that a complete change of active site polarity is not required for the successful conversion of aliphatic aldehydes and surprisingly was found more beneficial than charge neutral mutations. These results were rationalized in docking studies, where a molecule of water was identified at the center of a hydrogen bond network, essential for substrate binding and correct orientation towards the cofactor, thus allowing the conversion of aliphatic aldehydes in the charged active site of transketolase. Please click Additional Files below to see the full abstract

Moving beyond the ‘language problem': developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters

Health systems internationally are dealing with greater diversity in patient populations. However the focus on ‘the language problem’ has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health. Sur le plan international, des systèmes de santé font face à une diversité croissante dans ses populations de patients. Cependant, l’accent sur ‘le problème de langue’ se traduit dans une manque d’attention à la diversité a l’intérieur même et entre des populations des migrants; et la façon par laquelle des variables migratoire, ethnique et sociodémographique influencent elles-mêmes des consultations interprétées. Notre analyse des expériences des patients, des professionnels fournissant de soins de santé et des interprètes offre des preuves du besoin de dépasser le problème de langue. Et en faisant cela, nous adressons des multiples inégalités, souvent cachées dans des contextes de soins de santé, dans les milieux clinique et domicile. Nous proposons un programme de recherche basé sur la pratique, qui favorise la communication culturelle dans des milieux clinique et domicile, et qui reconnait le statut d’immigration comme un déterminant social de la santé

Analysis of the burden and economic impact of digestive diseases and investigation of research gaps and priorities in the field of digestive health in the European Region—White Book 2: Executive summary

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