In or out?: Exploring selection processes of farmers in cocoa sustainability standards and certification programmes in Ghana

The sustainability of the global cocoa sector is currently being tested by acute deforestation, rampant poverty among cocoa farmers and fears of future cocoa supply shortages. Cocoa Sustainability Standards and their subsequent Certifications (SSC) are seen as a win-win solution to these challenges for both farmers and the industry. Nevertheless, questions regarding who is able to participate and potentially benefit from such interventions and, just as importantly, who is not, remain under-researched. Taking Ghana, the world’s second-largest producer of certified cocoa, as a case study, this thesis draws on actor and network approaches (Long, 1989; Latour, 1987), theory-based evaluation (Weiss, 1997; Pawson and Tilley, 2004) and the Sustainable Rural Livelihoods framework (Scoones, 1998) to unpack selection processes. It uses primary qualitative data from industry informants and farmers from the Brong Ahafo region, as well as national level secondary quantitative survey data to understand how farmers are externally selected, through programme placement and participant targeting, and self selected into SSC programmes. Findings suggest that SSC placement is business-oriented when programmes are driven by SSC implementing actors, with farmer-centered criteria gaining influence when funding and certifying actors are involved. In terms of targeting, farmers lacking land entitlements, like sharecroppers and their wives, tend to be left out of SSC related activities and the distribution of benefits, even when producing certified cocoa. Further,farmers’ dependence on credit determines their selling strategies and therefore their self selection in or out of SSC programmes, when participation is conditional on selling to a particular buyer. In the absence of selling conditionality, selection is shaped by the farmers’ ability and willingness to adopt the standards. Overall, better-off farmers are more likely to participate in SSC programmes, while landless, credit-dependent and isolated farmers tend to be left out, suggesting that if SSC are to advance the interests of both farmers and industry, issues of inclusiveness need to be addressed both at the policy and implementation level

The challenges of screening and synthesizing qualitative research in a mixed-methods systematic review. The case of the impact of agricultural certification schemes

The number of mixed-methods systematic reviews in international development is growing in recent years. By recognising the value of qualitative research in providing valuable evidence on causal mechanisms, barriers, facilitators and the importance of context, mixed-methods systematic reviews go beyond the ‘what works’ question. However, appropriate methods to screen and synthesise qualitative evidence in these reviews are still in a development phase, and the methodological literature dealing with reviewing qualitative evidence in the field of development studies is scarce and under-developed. This paper aims to contribute to this gap by discussing the methodological and practical challenges of including qualitative evidence in a mixed-methods systematic review in international development. In particular, this article makes a contribution in terms of offering reviewers and users of systematic reviews a full account of the process of screening and synthesising a very large volume of heterogeneous qualitative studies. Using as an example a review on the effects of certification schemes for agricultural production, we report on each reviewing step, describing the problems encountered and solutions found. The paper proposes ways of extracting a large volume of data and integrating the qualitative synthesis with the evidence from the related quantitative effectiveness review

The effectiveness of agricultural certification in developing countries: a systematic review

Certification systems (CS) set and monitor voluntary standards to make agricultural production sustainable in socio-economic terms and agricultural trade fairer for producers and workers. They try to achieve a wide range of socio-economic and environmental effects through bundles of interventions that include the process of standard setting and compliance, advocacy among consumers, capacity building for producers, building supply chains, price interventions, and the application of acceptable labour standards, overall to improve the wellbeing of farmers and agricultural workers. This paper presents the results of a mixed-method systematic review that synthesized the literature on socio-economic effects of certification systems on agricultural producers and wage workers in low and middle income countries. The review followed the Campbell Collaboration guidelines for systematic reviews, and included studies published between 1990 and 2016 in different languages, with evidence on low and middle income countries. The review included a quantitative effectiveness question focused on a range of intermediate (e.g. prices, wages) and endpoint outcomes (e.g. household income). It also included a question on barriers, facilitators and contextual factors shaping effectiveness which drew on qualitative or mixed-method studies. Eligible certification systems were based on second- (industry-level) or third-party certifications, and excluded own-company standards. For the effectiveness review, quantitative impact evaluations must use experimental or non-experimental methods demonstrating control for selection bias. With these inclusion criteria, the review includes 43 studies used for analysing quantitative effects, and 136 qualitative studies for synthesizing barriers, enablers and other contextual factors. Most included studies report on initiatives in Latin America and sub-Saharan Africa and focus primarily on agricultural producers. The quality of the included studies is mixed, and several studies are weak on a number of methodological fronts, especially on statistical reporting. Overall, there is limited and mixed evidence on the effects of CS on a range of intermediate and final socio-economic outcomes for agricultural producers and wage workers. There are positive effects on prices and income from the sale of produce is higher for certified farmers. However, workers' wages do not seem to benefit from the presence of CS and, further along the causal chain, we find no evidence that total household income improves with certification. The integrated synthesis of quantitative and qualitative studies shows that context matters substantially in all causal chains and multiple factors shape the effectiveness and causal mechanisms that link interventions associated with certification and the wellbeing of producers, workers and their families

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A Repeated Cross-Sectional Pilot Study of Physical Activity, Levels of Depression and Anxiety during the COVID-19 Pandemic in Young Greek Adults

Regular physical activity (PA) and, more specifically, exercise, is associated with lower levels of stress, depression, and anxiety. The aim of this repeated cross-sectional pilot study was to investigate the impact of participating in PA on the mental health of young adults in Greece during the COVID-19 pandemic. The study was carried out during two quarantine periods: Survey I on 5 May 2020, and Survey II on 30 April 2021. The Hamilton Anxiety (HAM-A) and Beck Depression Inventory-II (BDI-II) scales and the level of PA were used to assess a sample of individuals aged between 18 and 26 years old. In 2020 and 2021, a total of 268 (33.9% males) and 380 (37.1% females) subjects participated in the studies, respectively. According to the findings, the vast majority of the participants in both samples reported that they are physically active (p = 0.86), while they consider exercise as a significant health factor (p = 0.10). Moreover, anxiety levels statistically significant increased (p = 0.001), while depression levels remained relatively stable with a slight increase of approximately (p > 0.05). Additionally, in both surveys, individuals who engaged in a PA program exhibited reduced levels of depression and anxiety (p = 0.001). Also, gender appears to influence anxiety and depression levels, while a lack of exercise exacerbates these measures in both genders when compared to physically active individuals. Concludingly, it is crucial for public health strategies to include interventions that promote safe PA in the event of future lockdowns or similar emergencies