Food Systems & Bonds

The following white paper is part of a series that builds the case for creating a defined food systems asset class in order to support the market growth of robust food systems throughout the country. There are significant opportunities for development finance agencies at the state and local level to support food businesses and projects.This paper focuses specifically on bond financing, which is  onsidered a 'bedrock tool' by the Council of Development Finance Agencies (CDFA) for the historic and foundational role bonds have played in public financing. Background information on bonds is provided, including different types of bonds, the key players involved in bond deals, and the process by which a bond is sold. Case studies will demonstrate the way in which various types of bonds can support food and agriculture businesses and projects, and also highlight sectors of the food system that could be utilizing bonds more frequently

CDFA Food Finance White Paper Series: Advancing Food Systems Through Development Finance

Announcing the release of the sixth and final white paper of the CDFA Food Finance White Paper Series, Advancing Food Systems Through Development Finance! Research on food systems finance and leadership with pilot projects has positioned CDFA to identify three key strategies for a comprehensive approach for restoring America's local food systems: Reframe food systems development as infrastructure and economic development; Build effective relationships and partnerships across the entire food system; and Plan for strategic food systems financing. The case studies showcase how such strategies can be put to work rebuilding the food system and emphasize the groundbreaking potential of greater connections between development finance and local food systems. Every organization, community, economic development agency, and small business working in the food sector should adopt the Reframe, Build, Plan approach to expand financing and drive capital into the local food system.

OSU InFACT Economic Development Financing Plan

CDFA worked with The Ohio State University's Initiative for Food and AgriCultural Transformation (InFACT) to develop an economic development finance plan that creates a new financing entity to build a more robust food system across the state of Ohio by unlocking capital for food-related businesses, projects, and infrastructure. This approach also integrated InFACT's technical assistance programming and supported generous research opportunities for the University's faculty and students

Transformative action coaching in healthcare leadership

The context of this study focuses on the collaborative interest of three organizations devoted to the development of Healthcare leadership in the United Kingdom, namely the National Health Service (NHS), Army Medical Service (AMS), and the University of Cumbria (UoC). Each organization acknowledges the challenges facing healthcare leaders in their pursuit of effect organizational, personal, and professional learning and have come together and bring into play their own organizational learning to collectively design this pilot programme of leadership development that facilitates deep transformative critical self- reflection, reflexivity and learning. The authors have used the theoretical and practical integration of autoethnographic storytelling and arts-based action learning approaches to facilitate such transformative learning in the group setting of professional leadership development programmes. The aim of this study is to add to the growing discourses in the fields of Transformative Learning, Action Learning, Coaching and Autoethnography by critically evaluating the application of this approach when designing and delivering a combined military, university and NHS leadership development program to a cohort of 24 senior leaders within an NHS hospital

A randomised trial of an eight-week, once weekly primaquine regimen to prevent relapse of plasmodium vivax in Northwest Frontier Province, Pakistan.

BACKGROUND: Vivax malaria remains a major cause of morbidity in the subtropics. To undermine the stability of the disease, drugs are required that prevent relapse and provide reservoir reduction. A 14-day course of primaquine (PQ) is effective but cannot safely be used in routine practice because of its interaction with glucose-6-phosphate dehydrogenase (G6PD) deficiency for which testing is seldom available. Safe and effective use of PQ without the need for G6PD testing would be ideal. The efficacy and safety of an 8-week, once weekly PQ regimen was compared with current standard treatment (chloroquine alone) and a 14-day PQ regimen. METHODS AND PRINCIPAL FINDINGS: 200 microscopically confirmed Plasmodium vivax patients were randomly assigned to either once weekly 8-week PQ (0.75 mg/kg/week), once weekly 8-week placebo, or 14-day PQ (0.5mg/kg/day) in North West Frontier Province, Pakistan. All patients were treated with a standard chloroquine dose and tested for G6PD deficiency. Deficient patients were assigned to the 8-week PQ group. Failure was defined as any subsequent episode of vivax malaria over 11 months of observation. There were 22/71 (31.0%) failures in the placebo group and 1/55 (1.8%) and 4/75 (5.1%) failures in the 14-day and 8-week PQ groups, respectively. Adjusted odds ratios were: for 8-week PQ vs. placebo-0.05 (95%CI: 0.01-0.2, p<0.001) and for 14-day PQ vs. placebo-0.01 (95%CI: 0.002-0.1, p<0.001). Restricted analysis allowing for a post-treatment prophylactic effect confirmed that the 8-week regimen was superior to current treatment. Only one G6PD deficient patient presented. There were no serious adverse events. CONCLUSIONS: A practical radical treatment for vivax malaria is essential for control and elimination of the disease. The 8-week PQ course is more effective at preventing relapse than current treatment with chloroquine alone. Widespread use of the 8-week regimen could make an important contribution to reservoir reduction or regional elimination where G6PD testing is not available. TRIAL REGISTRATION: ClinicalTrials.gov NCT00158587

Food Finance Detroit: A Landscape Map for Financing Detroits Local Food System

With funding from the W.K. Kellogg Foundation, CDFA is researching how development finance agencies can become more engaged in local and regional food systems. CDFA aims to advance opportunities and leverage existing financing streams to scale local and regional food systems by increasing access to healthy foods and creating new living wage and accessible jobs in communities across the country.

Cost-effectiveness of point-of-care C-Reactive Protein test compared to current clinical practice as an intervention to improve antibiotic prescription in malaria-negative patients in Afghanistan

Acknowledgments The paper was initially developed as part of an MSc dissertation by the lead author at the University of Aberdeen. The authors acknowledge the inputs from researchers into the primary data collection in 2009–2012 and CEA study for the introduction of Malaria RDTs in Afghanistan; not all of these authors met criterion for authorship on this paper.Peer reviewedPublisher PD

Towards a strategy for malaria in pregnancy in Afghanistan: analysis of clinical realities and women's perceptions of malaria and anaemia.

BACKGROUND: Afghanistan has some of the worst maternal and infant mortality indicators in the world and malaria is a significant public health concern. Study objectives were to assess prevalence of malaria and anaemia, related knowledge and practices, and malaria prevention barriers among pregnant women in eastern Afghanistan. METHODS: Three studies were conducted: (1) a clinical survey of maternal malaria, maternal anaemia, and neonatal birthweight in a rural district hospital delivery-ward; (2) a case-control study of malaria risk among reproductive-age women attending primary-level clinics; and (3) community surveys of malaria and anaemia prevalence, socioeconomic status, malaria knowledge and reported behaviour among pregnant women. RESULTS: Among 517 delivery-ward participants (1), one malaria case (prevalence 1.9/1000), 179 anaemia cases (prevalence 346/1000), and 59 low-birthweight deliveries (prevalence 107/1000) were detected. Anaemia was not associated with age, gravidity, intestinal parasite prevalence, or low-birthweight at delivery. Among 141 malaria cases and 1010 controls (2), no association was found between malaria infection and pregnancy (AOR 0.89; 95 % CI 0.57-1.39), parity (AOR 0.95; 95 % CI 0.85-1.05), age (AOR 1.02; 95 % CI 1.00-1.04), or anaemia (AOR 1.00; 95 % CI 0.65-1.54). Those reporting insecticide-treated net usage had 40 % reduced odds of malaria infection (AOR 0.60; 95 % CI 0.40-0.91). Among 530 community survey participants (3), malaria and anaemia prevalence were 3.9/1000 and 277/1000 respectively, with 34/1000 experiencing severe anaemia. Despite most women having no formal education, malaria knowledge was high. Most expressed reluctance to take malaria preventive medication during pregnancy, deeming it potentially unsafe. CONCLUSIONS: Given the low malaria risk and reported avoidance of medication during pregnancy, intermittent preventive treatment is hard to justify or implement. Preventive strategy should instead focus on long-lasting insecticidal nets for all pregnant women

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.&lt;p&gt;&lt;/p&gt; Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).&lt;p&gt;&lt;/p&gt; Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.&lt;p&gt;&lt;/p&gt; Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.&lt;p&gt;&lt;/p&gt