The Health Systems Funding Platform : is this where we thought we were going?

Background: In March 2009, the Task Force for Innovative International Financing for Health Systems recommended "a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies." Momentum to establish the Health Systems Funding Platform was swift, with the World Bank convening a Technical Workshop on Health Systems Strengthening (HSS), and serial meetings organized to progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. Methods: This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. Results: The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the conflict is tension between key global stakeholders over defining and ownership of the health systems agenda. Conclusions: The tensions appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic evolution, the Platform may offer an incremental path towards increasing integration around health systems, that has not been previously possible

Seed management by small-scale farmers in Zambia. A study of cowpea, groundnut and sorghum seed in the Southern and Western Provinces (NRI Bulletin 76)

Field surveys of on-farm cowpea, groundnut and sorghum management in two regions of Zambia are described. The survey included seed saved on-farm and seed sources off-farm. Samples of seeds were collected just prior to planting and assessed for germination potential. Conclusions are given on the general status and potential for improving seed quality and on farmer seed management

Does value chain inclusiveness increase smallholder resilience during pandemics? Lessons from the Zambia's sugar‐belt

This paper asks whether value chain integration increases smallholder resilience during shocks. Using a qualitative research study design and the test case of the ‘sugar-belt’ in Zambia, the paper draws on interviews with participants from different stakeholder groups, including household case studies and group discussions. Results show sugarcane value chain integration enhances smallholder livelihood resilience during pandemics through its coordination arrangement, but more could be done. Indirect involvement in, and joint procurement processes of inputs between smallholders and the management company, existing ready and stable access to markets and access to Fairtrade relief funds that point to direct livelihood support proved crucial for strengthening smallholder livelihood resilience during the pandemic. There were COVID-19-related adjustments by the management company, which further increased smallholder support. However, in as much as coordination arrangements seemed to have worked well during COVID-19, smallholder livelihoods remained narrow and risky, raising the need for diversification that could strengthen sustainable resilience. This paper sheds light on how value chains could be organised to enhance pandemic recovery and build livelihood resilience. It helps us to reflect on the ‘(in)effectiveness’ of value chain institutions and the role and importance of smallholder coordination arrangements during pandemics. Ultimately, the result is a contribution to livelihood resilience thinking in value chains—one we hope is appropriate to our conjuncture

A comparison between three legacy soil maps of Zambia at national scale: The spatial patterns of legend units and their relation to soil properties

We examined three soil maps of Zambia, two published at scales of 1:1 million – the Exploratory Soil Map of Zambia (ESMZ) and the Vegetation–Soil Map produced by Trapnell and colleagues in 1947 – and one at 1:3 million, the Soil Atlas of Africa (SAA). We estimated components of variance for measurements of clay, sand and organic carbon content and bulk density of the soil across the country using models which included different mean values for soil map units as random effects. For all but organic carbon content there was significant variation accounted for by differences between legend units for two of the maps, ESMZ with legend units based on the FAO-Unesco and SAA with legend units based on the World Reference Base respectively. This was despite their small cartographic scale. For the Vegetation–Soil Map, we examined differences between broad soil physiographic units. These did not account for significant variation in the soil properties. There were clear similarities between the soil physiographic units of the Soil–Vegetation Map and broader physiographic units into which the legend units of the ESMZ are grouped. The spatial pattern of soil units of the SAA was the most spatially heterogeneous, as measured by the sum of indicator variograms, despite being at the smallest published scale. It was apparent that some of the soil variation within the largest physiographic unit of the Soil–Vegetation Map, the Plateau Soils, as expressed by the map units of the SAA was significantly associated with the different vegetation units mapped in 1947. These studies show how quantitative assessment of legacy soil information may help us understand its potential and limitations

Is Dhaka Stock Exchange (DSE) Efficient? A Comparison of Efficiency Before and After the Market Crisis of 2010

This paper tests for the weak form of efficiency in DSE. A major objective of this paper is to compare and analyse the efficiency of the market before and after the market crash of December, 2010. The sample includes DSEGEN price index daily closing values. The data is divided among two time periods, year 2009-2010 is used to test the efficiency before the market crash and 2011-2012 is used to test the efficiency after the market crash. Kolmogorov-Smirnov and the Shaprio-Wilk tests are used to test the normality of returns and for both the time periods, the returns distributions are non normal. Runs test is used to test for the randomness of returns. The result of runs test is quite interesting. It shows that returns were not random before the market crash. Numerous other previous researches also show non randomness of returns in DSE. But surprisingly random walk is observed for the returns after the market crash. It requires further studies to understand such abnormality

Hypercalcemia in a patient with disseminated paracoccidioidomycosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hypercalcemia is well described in various granulomatous disorders, such as sarcoidosis, tuberculosis, berylliosis, leprosy and fungal infections. However, the association of <it>Paracoccidioides brasiliensis </it>and hypercalcemia is rare: to the best of our knowledge, only two cases have previously been reported, and neither had a clear documentation of the etiology of the hypercalcemia.</p> <p>Case presentation</p> <p>We report the case of a 22-year-old man in whom disseminated infection with paracoccidioidomycosis was associated with hypercalcemia. The patient had a high normal serum level of 1,25-dihydroxyvitamin D and a suppressed parathyroid hormone value, an indication that the hypercalcemia was not mediated by parathyroid hormone and might be associated with 1,25-dihydroxyvitamin D.</p> <p>Conclusion</p> <p>The episode resolved readily with administration of corticosteroids, an outcome suggesting that this is an effective treatment of hypercalcemia of this origin. On follow-up, while receiving antifungal therapy for <it>P. brasiliensis </it>the patient's calcium values remained normal.</p

Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial

Background: Pre-eclampsia is a leading cause of maternal and perinatal mortality. Evidence regarding interventions in a low-income or middle-income setting is scarce. We aimed to evaluate whether planned delivery between 34+ 0 and 36+ 6 weeks’ gestation can reduce maternal mortality and morbidity without increasing perinatal complications in India and Zambia. / Methods: In this parallel-group, multicentre, open-label, randomised controlled trial, we compared planned delivery versus expectant management in women with pre-eclampsia from 34+ 0 to 36+ 6 weeks’ gestation. Participants were recruited from nine hospitals and referral facilities in India and Zambia and randomly assigned to planned delivery or expectant management in a 1:1 ratio by a secure web-based randomisation facility hosted by MedSciNet. Randomisation was stratified by centre and minimised by parity, single-fetus pregnancy or multi-fetal pregnancy, and gestational age. The primary maternal outcome was a composite of maternal mortality or morbidity with a superiority hypothesis. The primary perinatal outcome was a composite of one or more of: stillbirth, neonatal death, or neonatal unit admission of more than 48 h with a non-inferiority hypothesis (margin of 10% difference). Analyses were by intention to treat, with an additional per-protocol analysis for the perinatal outcome. The trial was prospectively registered with ISRCTN, 10672137. The trial is closed to recruitment and all follow-up has been completed. / Findings: Between Dec 19, 2019, and March 31, 2022, 565 women were enrolled. 284 women (282 women and 301 babies analysed) were allocated to planned delivery and 281 women (280 women and 300 babies analysed) were allocated to expectant management. The incidence of the primary maternal outcome was not significantly different in the planned delivery group (154 [55%]) compared with the expectant management group (168 [60%]; adjusted risk ratio [RR] 0·91, 95% CI 0·79 to 1·05). The incidence of the primary perinatal outcome by intention to treat was non-inferior in the planned delivery group (58 [19%]) compared with the expectant management group (67 [22%]; adjusted risk difference –3·39%, 90% CI –8·67 to 1·90; non-inferiority p<0·0001). The results from the per-protocol analysis were similar. There was a significant reduction in severe maternal hypertension (adjusted RR 0·83, 95% CI 0·70 to 0·99) and stillbirth (0·25, 0·07 to 0·87) associated with planned delivery. There were 12 serious adverse events in the planned delivery group and 21 in the expectant management group. / Interpretation: Clinicians can safely offer planned delivery to women with late preterm pre-eclampsia, in a low-income or middle-income country. Planned delivery reduces stillbirth, with no increase in neonatal unit admissions or neonatal morbidity and reduces the risk of severe maternal hypertension. Planned delivery from 34 weeks’ gestation should therefore be considered as an intervention to reduce pre-eclampsia associated mortality and morbidity in these settings. / Funding: UK Medical Research Council and Indian Department of Biotechnology

Language policy and orthographic harmonization across linguistic, ethnic and national boundaries in Southern Africa

Drawing on online and daily newspapers, speakers' language and writing practices, official government documents and prescribed spelling systems in Southern Africa, the paper explores the challenges and possibilities of orthographic reforms allowing for mobility across language clusters, ethnicity, regional and national borders. I argue that this entails a different theorisation of language, and for orthographies that account for the translocations and diasporic nature of late modern African identities and lifestyles. I suggest an ideological shift from prescriptivism to practice-orientated approaches to harmonisation in which orthographies are based on descriptions of observable writing practices in the mobile linguistic universe. The argument for orthographic reforms is counterbalanced with an expose on current language policies which appear designed for an increasing rare monoglot 'standard' speaker, who speaks only a 'tribal' language. The implications of the philosophical challenges this poses for linguists, language planners and policy makers are thereafter discussed.IS