Reconstructing the Effectiveness of Policy Measures to Avoid Next-Wave COVID-19 Infections and Deaths Using a Dynamic Simulation Model:Implications for Health Technology Assessment

OBJECTIVE: The goal of this study was to dynamically model next-wave scenarios to observe the impact of different lockdown measures on the infection rates (IR) and mortality for two different prototype countries, mimicking the 1st year of the COVID-19 pandemic in Europe. METHODS: A dynamic simulation SIRD model was designed to assess the effectiveness of policy measures on four next-wave scenarios, each preceded by two different lockdowns. The four scenarios were (1) no-measures, (2) uniform measures, (3) differential measures based on isolating > 60 years of age group, and (4) differential measures with additional contact reduction measures for the 20–60 years of age group. The dynamic simulation model was prepared for two prototype European countries, Northwestern (NW) and Southern (S) country. Both prototype countries were characterized based on age composition and contact matrix. RESULTS: The results show that the outcomes of the next-wave scenarios depend on number of infections of previous lockdowns. All scenarios reduce the incremental deaths compared with a no-measures scenario. Differential measures show lower number of deaths despite an increase of infections. Additionally, prototype S shows overall more deaths compared with prototype NW due to a higher share of older citizens. CONCLUSION: This study shows that differential measures are a worthwhile option for controlling the COVID-19 epidemic. This may also be the case in situations where relevant parts of the population have taken up vaccination. Additionally, the effectiveness of interventions strongly depends on the number of previously infected individuals. The results of this study may be useful when planning and forecasting the impact of non-pharmacological interventions and vaccination campaigns

Reflecting on factors influencing long-lasting organisational effects of group model-building interventions

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Reflecting on factors influencing long-lasting organisational effects of group model-building interventions

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A cross-sectional study on attitudes toward gender equality, sexual behavior, positive sexual experiences, and communication about sex among sexually active and non-sexually active adolescents in Bolivia and Ecuador

Background: It is widely agreed upon that gender is a key aspect of sexuality however, questions remain on how gender exactly influences adolescents’ sexual health. Objective: The aim of this research was to study correlations between gender equality attitudes and sexual behavior, sexual experiences and communication about sex among sexually active and non-sexually active adolescents in 2 Latin American countries. Design: In 2011, a cross-sectional study was carried out among 5,913 adolescents aged 14–18 in 20 secondary schools in Cochabamba (Bolivia) and 6 secondary schools in Cuenca (Ecuador). Models were built using logistic regressions to assess the predictive value of attitudes toward gender equality on adolescents’ sexual behavior, on experiences and on communication. Results: The analysis shows that sexually active adolescents who consider gender equality as important report higher current use of contraceptives within the couple. They are more likely to describe their last sexual intercourse as a positive experience and consider it easier to talk with their partner about sexuality than sexually experienced adolescents who are less positively inclined toward gender equality. These correlations remained consistent whether the respondent was a boy or a girl. Non-sexually active adolescents, who consider gender equality to be important, are more likely to think that sexual intercourse is a positive experience. They consider it less necessary to have sexual intercourse to maintain a relationship and find it easier to communicate with their girlfriend or boyfriend than sexually non-active adolescents who consider gender equality to be less important. Comparable results were found for boys and girls. Conclusions: Our results suggest that gender equality attitudes have a positive impact on adolescents’ sexual and reproductive health (SRH) and wellbeing. Further research is necessary to better understand the relationship between gender attitudes and specific SRH outcomes such as unwanted teenage pregnancies and sexual pleasure among adolescents worldwide

The power of small size economies in south america on international insertion : a special focus on Bolivia

Depuis les années 60, l'Amérique Latine avait accueilli les suggestions des organismes économiques internationaux (OEIs) sur la façon de réussir le développement. Dans les années 70, les Nations Unies ont suggéré la politique où les pays pourraient définir indépendamment leur propre politique nationale et internationale pour atteindre leur développement. Cela n'a pas fonctionné en raison de l'interdépendance croissante (de quoi ?); donc, dans la deuxième moitié des années 80, le Consensus de Washington a remplacé cette politique. Le Consensus de Washington disait que, la globalisation favorise le multilatéralisme dans la mesure où un pays ne peut pas prendre unilatéralement des décisions qui affecteront d'autres pays. Et même que cela paraît-t il vraisemblable, il signifierait que le libre-échange doit régner en maître et au-dessus des actions des Etats, éliminant tout entrave aux échanges et aux investissements à l'étranger. Selon la Commission des Nations Unies pour le Commerce et le Développement (CNUCED), « la production internationale est devenue la caractéristique structurale centrale de l'économie mondiale ». Une plus grande liberté de commerce et une large ouverture aux mouvements de capitaux, pourrai mener les nations sous-développés à la croissance économique comparable à celle des pays riches. En conséquence, beaucoup de pays latino-américains qui avaient rejoint entretemps le néolibéralisme proposé par le Consensus de Washington en 1989, ont ainsi mise en place des mesures visant à réduire les entraves au commerce : ils ont ouvert leurs marchés aux capitaux étrangers et suivi plusieurs des indications des OEIs ; le but étant le développement par l'internationalisation. Des économies nationales rejoignent ainsi un réseau du commerce international, d'investissement et de crédit où le commerce devait apporter le développement. Les OEIs ont indiqué que la taille du marché national n'importe plus si un pays se focalise sur de plus grands marchés internationaux. L'internalisation des normes de Consensus de Washington était difficile pour les SSE parce que les règles de ce consensus les ont pris en tant que groupe « d'une taille unique, ouvert, juste, établie sur le terrain d'une régulation non discriminatoires » approchez pour la multilatéralisation du commerce et du développement. Cependant, les SSE n'ont pas tiré profit de ces mesures car ils ne faisaient pas le poids des puissances au point d'influencer les règlements du libre échange et de la libéralisation de l'investissement directe étrangère (ou IDE). Ils n´ont pas la capacité ni le pouvoir de changer la structure des normes à l'intérieur des OEIs, où les politiques et les lois internationales sont suggérées sans prendre en considération des privilèges particuliers ni les besoins propre à chacun. Cette marginalisation dans la scène internationale accentue les problèmes économiques et sociaux qui sont à l'origine de l'agitation sociale constante et mettent en péril la stabilité de leur gouvernement. Plusieurs chercheurs et gouvernements ne perçoivent pas ces vrais problèmes et ne peuvent pas ainsi prévoir des mesures proportionnées pendant les négociations internationales. Le pire est que, les EPT ne connaissent pas eux même leur faiblesses et comment les évaluez. Avec cette thèse, nous voulons explorer la capacité d'insertion des EPT sur la scène internationale. De ce fait, la thèse est divisée en deux parties : dans la première partie, nous analyserons pourquoi après plusieurs années de multilatéralisme proposé par les OEIs, aucune amélioration en termes de l'internationalisation et du développement de certains pays sud-américains n'a été constaté ; mais au contraire, il y a eu un accroissement de la pauvreté. Nous pensons que c'est le fait que la scène internationale a été ordonnée seulement par les plus grandes économies laissant de côte la majorité des pays en voie de développement et leurs besoins.Since the 60s, Latin America has been hearing the suggestions of International Economic Organizations (IEOs) on how to reach development. In the 70s, the United Nations suggested the politics of development, where the countries could define independently their own national and international politics to reach development and be equally rich. This did not work due to the increasing interdependence; therefore, in the second half of the 80s, the Washington Consensus replaced this policy. The Washington Consensus claims that globalization promotes multilateralism and does not allow countries to take unilateral decisions because they affect others and are being affected by other countries' decisions as well. Although this made a lot of sense, it would mean that the free market prevailed over the actions of the government, eliminating all barriers to trade and to foreign investments. According to the United Nations Commission for Trade and Development (UNCTAD), "International production has become the central structural characteristic of the world economy”. A greater freedom to trade, plus the opening of capital flows, could lead the underdeveloped nations to economic growth showing as a sample the rich countries. Therefore, many Latin American countries joined the neoliberalism that was proposed by the Washington Consensus in 1989, reduced trade barriers, opened up their markets to foreign capitals and followed many of the indications of the IEOs in order to find development through internationalization. National economies are linked together by a network of trade, investment and credit and this link is supposed to bring development. The IEOs said that the national market size does not matter anymore if a country focuses on larger international markets. Internalizing the Washington Consensus norms was difficult for Small Size Economies (SSE) because the rules of this Consensus took all the countries as a group of a unique size and established on common and non discriminatory rules to approach multilateralization. However, the SSE had no part of the cake and no power to influence the regulations of free trade and foreign direct investment (FDI) liberalization. The same, they do not have the capacity or power to change the norm structure inside the IEOs (where policies and international laws are suggested) that could take them into account with particular privileges according to their specific needs. This marginalization in the international arena is believed to have accentuated economic and social problems that now keep them in constant social turmoil and put in risk their government's stability. Several researches and governments do not perceive this problem and cannot foresee adequate reactions in international negotiations. Worst, SSE do not know themselves what are their weakness and how to asses them. With this thesis, we want to explore the power of SSE on international insertion. For this, the thesis is divided in two parts. The problem that we want to analyze in the first part is why after several years of multilateralism proposed by the IEOs, internationalization and development did not improve for some of the South American countries increasing poverty. It seem that the reason lies in the fact that the international arena was only ruled by the largest economies leaving aside to the majority of the developing countries and their needs. This is why we wanted to explore (main goal) under what circumstances multilateralism and the Washington Consensus was applied, which were the options to improve the situation within multilateralism and what was the impact of multilateralism as proposed by the IEOs in terms of internationalization and development

Le pouvoir des économies de petite taille en Amérique du sud à leur insertion internationale

Since the 60s, Latin America has been hearing the suggestions of International Economic Organizations (IEOs) on how to reach development. In the 70s, the United Nations suggested the politics of development, where the countries could define independently their own national and international politics to reach development and be equally rich. This did not work due to the increasing interdependence; therefore, in the second half of the 80s, the Washington Consensus replaced this policy. The Washington Consensus claims that globalization promotes multilateralism and does not allow countries to take unilateral decisions because they affect others and are being affected by other countries' decisions as well. Although this made a lot of sense, it would mean that the free market prevailed over the actions of the government, eliminating all barriers to trade and to foreign investments. According to the United Nations Commission for Trade and Development (UNCTAD), "International production has become the central structural characteristic of the world economy”. A greater freedom to trade, plus the opening of capital flows, could lead the underdeveloped nations to economic growth showing as a sample the rich countries. Therefore, many Latin American countries joined the neoliberalism that was proposed by the Washington Consensus in 1989, reduced trade barriers, opened up their markets to foreign capitals and followed many of the indications of the IEOs in order to find development through internationalization. National economies are linked together by a network of trade, investment and credit and this link is supposed to bring development. The IEOs said that the national market size does not matter anymore if a country focuses on larger international markets. Internalizing the Washington Consensus norms was difficult for Small Size Economies (SSE) because the rules of this Consensus took all the countries as a group of a unique size and established on common and non discriminatory rules to approach multilateralization. However, the SSE had no part of the cake and no power to influence the regulations of free trade and foreign direct investment (FDI) liberalization. The same, they do not have the capacity or power to change the norm structure inside the IEOs (where policies and international laws are suggested) that could take them into account with particular privileges according to their specific needs. This marginalization in the international arena is believed to have accentuated economic and social problems that now keep them in constant social turmoil and put in risk their government's stability. Several researches and governments do not perceive this problem and cannot foresee adequate reactions in international negotiations. Worst, SSE do not know themselves what are their weakness and how to asses them. With this thesis, we want to explore the power of SSE on international insertion. For this, the thesis is divided in two parts. The problem that we want to analyze in the first part is why after several years of multilateralism proposed by the IEOs, internationalization and development did not improve for some of the South American countries increasing poverty. It seem that the reason lies in the fact that the international arena was only ruled by the largest economies leaving aside to the majority of the developing countries and their needs. This is why we wanted to explore (main goal) under what circumstances multilateralism and the Washington Consensus was applied, which were the options to improve the situation within multilateralism and what was the impact of multilateralism as proposed by the IEOs in terms of internationalization and development.Depuis les années 60, l'Amérique Latine avait accueilli les suggestions des organismes économiques internationaux (OEIs) sur la façon de réussir le développement. Dans les années 70, les Nations Unies ont suggéré la politique où les pays pourraient définir indépendamment leur propre politique nationale et internationale pour atteindre leur développement. Cela n'a pas fonctionné en raison de l'interdépendance croissante (de quoi ?); donc, dans la deuxième moitié des années 80, le Consensus de Washington a remplacé cette politique. Le Consensus de Washington disait que, la globalisation favorise le multilatéralisme dans la mesure où un pays ne peut pas prendre unilatéralement des décisions qui affecteront d'autres pays. Et même que cela paraît-t il vraisemblable, il signifierait que le libre-échange doit régner en maître et au-dessus des actions des Etats, éliminant tout entrave aux échanges et aux investissements à l'étranger. Selon la Commission des Nations Unies pour le Commerce et le Développement (CNUCED), « la production internationale est devenue la caractéristique structurale centrale de l'économie mondiale ». Une plus grande liberté de commerce et une large ouverture aux mouvements de capitaux, pourrai mener les nations sous-développés à la croissance économique comparable à celle des pays riches. En conséquence, beaucoup de pays latino-américains qui avaient rejoint entretemps le néolibéralisme proposé par le Consensus de Washington en 1989, ont ainsi mise en place des mesures visant à réduire les entraves au commerce : ils ont ouvert leurs marchés aux capitaux étrangers et suivi plusieurs des indications des OEIs ; le but étant le développement par l'internationalisation. Des économies nationales rejoignent ainsi un réseau du commerce international, d'investissement et de crédit où le commerce devait apporter le développement. Les OEIs ont indiqué que la taille du marché national n'importe plus si un pays se focalise sur de plus grands marchés internationaux. L'internalisation des normes de Consensus de Washington était difficile pour les SSE parce que les règles de ce consensus les ont pris en tant que groupe « d'une taille unique, ouvert, juste, établie sur le terrain d'une régulation non discriminatoires » approchez pour la multilatéralisation du commerce et du développement. Cependant, les SSE n'ont pas tiré profit de ces mesures car ils ne faisaient pas le poids des puissances au point d'influencer les règlements du libre échange et de la libéralisation de l'investissement directe étrangère (ou IDE). Ils n´ont pas la capacité ni le pouvoir de changer la structure des normes à l'intérieur des OEIs, où les politiques et les lois internationales sont suggérées sans prendre en considération des privilèges particuliers ni les besoins propre à chacun. Cette marginalisation dans la scène internationale accentue les problèmes économiques et sociaux qui sont à l'origine de l'agitation sociale constante et mettent en péril la stabilité de leur gouvernement. Plusieurs chercheurs et gouvernements ne perçoivent pas ces vrais problèmes et ne peuvent pas ainsi prévoir des mesures proportionnées pendant les négociations internationales. Le pire est que, les EPT ne connaissent pas eux même leur faiblesses et comment les évaluez. Avec cette thèse, nous voulons explorer la capacité d'insertion des EPT sur la scène internationale. De ce fait, la thèse est divisée en deux parties : dans la première partie, nous analyserons pourquoi après plusieurs années de multilatéralisme proposé par les OEIs, aucune amélioration en termes de l'internationalisation et du développement de certains pays sud-américains n'a été constaté ; mais au contraire, il y a eu un accroissement de la pauvreté. Nous pensons que c'est le fait que la scène internationale a été ordonnée seulement par les plus grandes économies laissant de côte la majorité des pays en voie de développement et leurs besoins

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: A retrospective analysis

Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains communication with parents, partners and peers; access to SRH information; access to …Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains communication with parents, partners and peers; access to SRH information; access to 

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis

Resumen Antecedentes La salud sexual y reproductiva de los adolescentes (SSR), como problemas de embarazos no planificados son complejos y multifactoriales, por lo que requieren múltiples intervenciones para su prevención. Evaluar el impacto de estas intervenciones es importante para asegurar la eficiencia, la eficacia y la rendición de cuentas para los donantes de proyectos y los miembros de la comunidad. En este estudio, proponemos la Gestión Basada en Resultados (o su sigla en inglés RBM) como un marco para la gestión de proyectos, utilizando el Community Embedded Reproductive Health Care for Adolescents (CERCA) como un caso de estudio para RBM. El Proyecto CERCA (2010-2014) puso a prueba las intervenciones para reducir el embarazo adolescente en tres países de América Latina, Bolivia, Ecuador y Nicaragua. Las actividades fueron diseñadas para mejorar los comportamientos adolescentes en SRH en cuatro aspectos: comunicación con padres, compañeros y pareja; acceso a la información sobre SSR; acceso a los servicios de SSR; y uso de anticonceptivos. Cuando el proyecto terminó, la evaluación de resultados mostró un impacto limitado sobre todo por la precisión en el monitoreo y pérdidas en el seguimiento de cohortes. Métodos Se revisó y analizó una serie de documentos CERCA y fuentes de datos relacionados. Las principales conclusiones de estos documentos se organizaron en el marco lógico de la Gestión Basada en Resultados (planificación, monitoreo y evaluación del impacto) para comprender cómo la metodología y el rendimiento de CERCA podrían haber obtenido mejores resultados. Resultados Se identificaron fortalezas y debilidades en los tres elementos del marco de RBM. En la Planificación, la propuesta Teoría del Cambio (ToC) difiere de la que se llevó a cabo en el paquete de intervención. Cada país implementó un paquete de intervención diferente sin supuestos articulados sobre cómo estas actividades de intervención producirían cambios. En el Monitoreo, la gestión del proyecto se basó principalmente en requisitos administrativos y financieros en lugar de supervisar la fidelidad y la calidad de las actividades de intervención. En la Evaluación de Impacto, la evaluación original del CERCA evaluó los efectos de la intervención entre los adolescentes, sin identificar los factores de éxito y fracaso relacionados con los resultados, la naturaleza de los resultados o el análisis de costo-efectividad de las intervenciones. Conclusiones Este análisis mostró que los proyectos multinacionales son complejos, implican riesgos en la ejecución y requieren una gestión del proyecto sólida. La Gestión Basada en Resultados puede ser una herramienta útil para garantizar un enfoque sistemático en las distintas fases de un proyecto bajo un contexto multi-país

Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals

Abstract Introduction Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. Methods This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators. Results While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse. Conclusion There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators