Sustainability of donor programs: evaluating and informing the transition of a large HIV prevention program in India to local ownership

Sustainability is the holy grail of many development projects, yet there is limited evidence about strategies that effectively support transition of programs from donor funding to national governments. The first phase of Avahan, the India AIDS Initiative supported by the Bill and Melinda Gates Foundation (2003–2009), aimed to demonstrate an HIV/AIDS prevention program at scale, primarily targeted at high-risk groups. During the second phase (2009–2013), this large-scale program will be transitioned to its natural owners: the Government of India and local communities. This paper describes the evaluation design for the Avahan transition strategy.A detailed logic model for the transition was developed. The Avahan transition strategy focuses on three activities: 1 enhancing capacities among communities, non-governmental organizations (NGOs), and government entities, in line with India's national AIDS control strategy; 2 aligning technical and managerial aspects of Avahan programs with government norms and standards; and 3 promoting and sustaining commitment to services for most-at-risk populations. It is anticipated that programs will then transfer smoothly to government and community ownership, become institutionalized within the government system, and support a sustained HIV/AIDS response.The research design evaluates the implementation and effectiveness of 1 activities undertaken by the program; 2 intermediate effects including the process of institutionalization and the extent to which key Avahan organizational procedures and behaviors are integrated into government systems; and 3 overarching effects namely the impact of the transition process on the sustained delivery of HIV/AIDS prevention services to high-risk groups. Both qualitative and quantitative research approaches are employed so that the evaluation will both assess outcomes and explain why they have occurred.It is unusual for donor-supported projects in low- and middle-income countries to carefully plan transition processes, and prospectively evaluate these. This evaluation is designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs

An Evolutionary Upgrade of Cognitive Load Theory: Using the Human Motor System and Collaboration to Support the Learning of Complex Cognitive Tasks

Cognitive load theory is intended to provide instructional strategies derived from experimental, cognitive load effects. Each effect is based on our knowledge of human cognitive architecture, primarily the limited capacity and duration of a human working memory. These limitations are ameliorated by changes in long-term memory associated with learning. Initially, cognitive load theory's view of human cognitive architecture was assumed to apply to all categories of information. Based on Geary's (Educational Psychologist 43, 179-195 2008; 2011) evolutionary account of educational psychology, this interpretation of human cognitive architecture requires amendment. Working memory limitations may be critical only when acquiring novel information based on culturally important knowledge that we have not specifically evolved to acquire. Cultural knowledge is known as biologically secondary information. Working memory limitations may have reduced significance when acquiring novel

Attention to Body-Parts Varies With Visual Preference and Verb–Effector Associations

Theories of embodied conceptual meaning suggest fundamental relations between others’ actions, language, and our own actions and visual attention processes. Prior studies have found that when people view an image of a neutral body in a scene they first look toward, in order, the head, torso, hands, and legs. Other studies show associations between action verbs and the body-effectors used in performing the action (e.g., “jump” with feet/legs; “talk” with face/head). In the present experiment, the visual attention of participants was recorded with a remote eye-tracking system while they viewed an image of an actor pantomiming an action and heard a concrete action verb. Participants manually responded whether or not the action image was a good example of the verb they heard. The eye-tracking results confirmed that participants looked at the head most, followed by the hands, and the feet least of all; however, visual attention to each of the body-parts also varied as a function of the effector associated with the spoken verb on image/verb congruent trials, particularly for verbs associated with the legs. Overall, these results suggest that language influences some perceptual processes; however, hearing auditory verbs did not alter the previously reported fundamental hierarchical sequence of directed attention, and fixations on specific body-effectors may not be essential for verb comprehension as peripheral visual cues may be sufficient to perform the task

Futile, non-beneficial, potentially inappropriate or ‘disputed’ treatment

This chapter examines the concept of futility in end-of-life decision-making. The term is generally used to describe the situation where the clinical treating team consider potentially life-sustaining treatment should not be provided. But the term ‘futility’ is a vexed one. Alternative terminology has been proposed such as ‘non-beneficial’ or ‘potentially inappropriate’ treatment. We contribute to these debates by offering another term – ‘disputed treatment’ – albeit one more limited in its application to where there is a disagreement about treatment. The chapter then traces key debates in the literature including attempts to define the term futility conceptually, and later empirically. A more recent body of work has also proposed a procedural approach to resolving futility disputes. Unsurprisingly, given the subjectivity of this concept, all of these approaches have been critiqued and these objections are considered. The chapter also considers the value of a concept like futility and its relationship with the distinct issue of health rationing. A final contribution is to offer an alternative approach to disputes about treatment that challenges the idea that futility decisions are ones for doctors, but also constrains the power of patients and substitute decision-makers to demand treatment