Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study

INTRODUCTION: Micro-health insurance (MHI) has been identified as a possible interim solution to foster progress towards Universal Health Coverage (UHC) in low- and middle- income countries (LMICs). Still, MHI schemes suffer from chronically low penetration rates, especially in sub-Saharan Africa. Initiatives to promote and sustain enrolment have yielded limited effect, yet little effort has been channelled towards understanding how such initiatives are implemented. We aimed to fill this gap in knowledge by examining heterogeneity in implementation outcomes and their moderating factors within the context of the Redesigned Community Health Fund in the Dodoma region in Tanzania. METHODS: We adopted a mixed-methods design to examine implementation outcomes, defined as adoption and fidelity of implementation (FOI) as well as their moderating factors. A survey questionnaire collected individual level data and a document review checklist and in-depth interview guide collected district level data. We relied on descriptive statistics, a chi square test and thematic analysis to analyse our data. RESULTS: A review of district level data revealed high adoption (78%) and FOI (77%) supported also by qualitative interviews. In contrast, survey participants reported relatively low adoption (55%) and FOI (58%). Heterogeneity in adoption and FOI was observed across the districts and was attributed to organisational weakness or strengths, communication and facilitation strategies, resource availability (fiscal capacity, human resources and materials), reward systems, the number of stakeholders, leadership engagement, and implementer's skills. At an individual level, heterogeneity in adoption and FOI of scheme components was explained by the survey participant's level of education, occupation, years of stay in the district and duration of working in the scheme. For example, the adoption of job description was statistically associated with occupation (p = 0.001) and wworking in the scheme for more than 20 months had marginal significant association with FOI (p = 0.04). CONCLUSION: The study demonstrates that assessing the implementation processes helps to detect implementation weaknesses and therefore address such weaknesses as the interventions are implemented or rolled out to other settings. Attention to contextual and individual implementer elements should be paid in advance to adjust implementation strategies and ensure greater adoption and fidelity of implementation

Effects of residue management on decomposition in irrigated rice fields are not related to changes in the decomposer community

Copyright: © 2015 Schmidt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Decomposers provide an essential ecosystem service that contributes to sustainable production in rice ecosystems by driving the release of nutrients from organic crop residues. During a single rice crop cycle we examined the effects of four different crop residue management practices (rice straw or ash of burned straw scattered on the soil surface or incorporated into the soil) on rice straw decomposition and on the abundance of aquatic and soildwelling invertebrates. Mass loss of rice straw in litterbags of two different mesh sizes that either prevented or allowed access of meso- and macro-invertebrates was used as a proxy for decomposition rates. Invertebrates significantly increased total loss of litter mass by up to 30%. Initially, the contribution of invertebrates to decomposition was significantly smaller in plots with rice straw scattered on the soil surface; however, this effect disappeared later in the season. We found no significant responses in microbial decomposition rates to management practices. The abundance of aquatic fauna was higher in fields with rice straw amendment, whereas the abundance of soil fauna fluctuated considerably. There was a clear separation between the overall invertebrate community structure in response to the ash and straw treatments. However, we found no correlation between litter mass loss and abundances of various lineages of invertebrates. Our results indicate that invertebrates can contribute to soil fertility in irrigated paddy fields by decomposing rice straw, and that their abundance as well as efficiency in decomposition may be promoted by crop residue management practices

Indicators for Monitoring Sustainable Development Goals: An Application to Oceanic Development in the European Union

The 2030 Agenda for Sustainable Development includes a set of 17 Sustainable Development Goals (SDG) with 169 specific targets. As such, it could be a step forward in achieving efficient governance and policies for global sustainable development. However, the current indicator framework with its broad set of individual indicators prevents straightforward assessment of synergies and trade-offs between the various indicators, targets, and goals thus heightening the significance of policy guidance in achieving sustainable development. With our detailed analysis of SDG 14 (Ocean) for European Union coastal states, we demonstrate how the (complementary) inclusion of composite indicators that aggregate the individual indicators by applying a generalized mean can provide important additional information and facilitate the assessment of sustainable development in general and in the SDG context in particular. Embedded in the context of social choice theory, the generalized mean varies the specification of substitution elasticity and thus allows a) for a straightforward distinction between a concept of weak and strong sustainability and b) for straightforward sensitivity analysis. We show that while in general the EU coastal states have a fairly balanced record at the SDG 14 level, certain countries like Slovenia and Portugal with a fairly balanced and a fairly unbalanced showing, respectively, rank very differently in terms of the two concepts of strong sustainability

Study of dimuon production in Indium-Indium collisions with the NA60 experiment

The NA60 experiment at the CERN-SPS is devoted to the study of dimuon production in heavy-ion and proton-nucleus collisions. We present preliminary results from the analysis of Indium-Indium collisions at 158 GeV per nucleon. The topics covered are low mass vector meson production, J/psi production and suppression, and the feasibility of the open charm measurement from the dimuon continuum in the mass range below the J/psi peak.Comment: Contribution at XXXXth Rencontres de Moriond, "QCD and High Energy Hadronic Interactions

First results from the NA60 experiment at CERN

Since 1986, several heavy ion experiments have studied some signatures of the formation of the quark-gluon plasma and a few exciting results have been found. However, some important questions are still unanswered and require new measurements. The NA60 experiment, with a new detector concept that vastly improves dimuon detection in proton-nucleus and heavy-ion collisions, studies several of those open questions, including the production of open charm. This paper presents the experiment and some first results from data collected in 2002.Comment: Paper presented at the XXXVIII Rencontres de Moriond, QCD and High Energy Hadronic Interactions, Les Arcs, March 22-29, 2003. 4 pages, 6 figure