Lay health workers and HIV programmes: Implications for health systems

One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.International Bibliography of Social Science

Towards a Comprehensive Understanding of Fertility: The Model of Dyadic Pathways

In this theoretical contribution, we propose a comprehensive and integrative heuristic model to explain fertility, the Model of Dyadic Pathways (MDP). We show how existing models such as the Theory of Planned Behaviour often do not withstand empirical challenges, especially not individual self-reports in qualitative studies. Furthermore, existing models vary in their premises and foci, resulting in a collection of models which do not necessarily align with or supplement one another. For these reasons, these heuristic models have been widely criticised and, in practice, pieced together according to the research question and tradition of the researcher. Against this backdrop, we establish the MDP to reconnect theory with reality and to unify a variety of approaches. The MDP is grounded on the dyad of partners as the prevalent basis of fertility. It integrates reasoned and unreasoned fertility behaviour, the impact of individual- and couple-level life course, soci(et)al conditions, and the body as an “actor”. The model explicitly accounts for the variety of different real-life pathways that lead to fertility. It thereby encourages researchers to, first, consider all potentially relevant factors and their mechanisms and, second, think of fertility and its measurement as a multilinear process. Based on the presented elements a comprehensive model of fertility must cover, we suggest ways to improve surveys accordingly. Furthermore, we elaborate on the contributions and challenges the MDP presents to future fertility research

Towards a Comprehensive Understanding of Fertility: The Model of Dyadic Pathways

In this theoretical contribution, we propose a comprehensive and integrative heuristic model to explain fertility, the Model of Dyadic Pathways (MDP). We show how existing models such as the Theory of Planned Behaviour often do not withstand empirical challenges, especially not individual self-reports in qualitative studies. Furthermore, existing models vary in their premises and foci, resulting in a collection of models which do not necessarily align with or supplement one another. For these reasons, these heuristic models have been widely criticised and, in practice, pieced together according to the research question and tradition of the researcher. Against this backdrop, we establish the MDP to reconnect theory with reality and to unify a variety of approaches. The MDP is grounded on the dyad of partners as the prevalent basis of fertility. It integrates reasoned and unreasoned fertility behaviour, the impact of individual- and couple-level life course, soci(et)al conditions, and the body as an "actor". The model explicitly accounts for the variety of different real-life pathways that lead to fertility. It thereby encourages researchers to, first, consider all potentially relevant factors and their mechanisms and, second, think of fertility and its measurement as a multilinear process. Based on the presented elements a comprehensive model of fertility must cover, we suggest ways to improve surveys accordingly. Furthermore, we elaborate on the contributions and challenges the MDP presents to future fertility research

Practicing governance towards equity in health systems: LMIC perspectives and experience.

The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity.The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in this series is thus to provide an empirical and embedded research perspective on governance and equity in health systems

Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany:Factors Associated with Time to First and Full Return to Work

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW. Clinical Registration Number DRKS00010903, retrospectively registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10926-021-09985-4

Boundary-spanning: reflections on the practices and principles of Global Health.

As Global Health evolves, not merely as a metaphor for international collaboration, but as a distinct field of practice, it warrants greater consideration of how it is practiced, by whom, and for what goals. We believe that, to become more relevant for the health systems and communities that are their intended beneficiaries, Global Health practices must actively span and disrupt boundaries of geography, geopolitics and constituency, some of which are rooted in imbalances of power and resources. In this process, fostering cross-country learning networks and communities of practice, and building local and national institutions with a global outlook in low and middle-income countries, are critically important. Crucially, boundary-spanning practices in Global Health require a mindset of inclusiveness, awareness of and respect for different coexisting realities

The murine nuclear orphan receptor GCNF is expressed in the XY body of primary spermatocytes

AbstractWe have studied the expression of the nuclear orphan receptor GCNF (germ cell nuclear factor) on the mRNA and protein level in pubertal and adult mouse testes. We show by Northern and Western blot analyses and by in situ hybridization that GCNF is expressed in spermatocytes and round spermatids of adult mouse testis suggesting that GCNF may be a transcriptional regulator of spermatogenesis. Since the GCNF protein is accumulated in the XY body of late pachytene spermatocytes, it may be involved in transcriptional inactivation of sex chromosomes

Policy adoption and the implementation woes of the intersectoral first 1000 days of childhood initiative, in the Western Cape province of South Africa

There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care

The first thousand days within the Western Cape whole of society approach: Lessons for the collaborative governance of intersectoral action for health

This report is a case study of the Western Cape’s Whole of Society Approach (WoSA) through the lens of the First Thousand Days (FTD) of childhood initiative, focusing in particular on its implementation in Saldanha Bay and to a limited extent the Drakenstein municipal areas/sub-districts. The case study reports on data collected by Ida Okeyo as part of her PhD, which has examined the emergence and implementation of FTD in the Province as a whole over the last 3-4 years. Experiences in Saldanha Bay and Drakenstein stand in contrast to elsewhere in the Province, where, despite original intentions, the FTD strategy has failed to take root as a cohesive intersectoral response to this critical moment in the lifecourse. This case study examines how WoSA (and the Better Spaces initiative before that), created an enabling context for intersectoral action within which FTD found a natural home. We spell out the elements of this enabling environment using a framework of ‘collaborative governance’, concluding that these elements are the necessary pre-conditions for advancing any intersectoral initiative more widely in the Western Cape Province and elsewhere. In this way, we aim to document and affirm lessons learnt through WoSA, and provide the case for its further development and institutionalisation in the Province

Roadmap zur Kundenakzeptanz: Zentrale Ergebnisse der sozialwissenschaftlichen Begleitforschung in den Modellregionen

--Elektromobilität