Financial Risk, Innovation and Alternative Pathways to Decarbonising the Energy System in 2050

There is a lot of forward looking work attempting to envisage the decarbonised energy system of the future as reflected with current interest in 'smart grids'. A central tenet behind most visions of the 'smart grids' of the future are the price signals that financial and commodity markets will deliver to facilitate effective and efficient resource allocation. Most of these visions take stylised and static views of financial and commodity markets despite the fact that these markets are experiencing dramatic change due to innovation and regulation. Accordingly, the paper maps the risks associated in the fusion of financial innovation with innovation in the energy system through a theoretical framework that draws on evolutionary models of paradigm shift. Risks to both the financial and energy systems are characterised as either emanating from primary or secondary markets and these are explored in terms of alternative visions of the energy system in the long run

The Impact of Risk Factors and Regulatory Change in the Returns of European Energy Utilities

This thesis examines the risk factors affecting the returns of European energy utilities. Since 1996, European energy utilities have been impacted by changing commodity dynamics and European Union (EU) -induced policy challenges, including liberalisation and environmental objectives, which are materially affecting financial return. The EU’s drive to create a single European energy market and the ‘greening’ of energy supply have been described as the world’s most extensive cross-border reforms of energy networks and operating structure. Commentators suggest that these changes have resulted in a €500 billion loss in market value. Thus, understanding the risk factors and impact of policy on the financial return and valuation of European energy utilities is of utmost importance. This thesis represents the most comprehensive analysis of these changes to date, employing a sample of 88 energy utilities and 54 regulatory changes between 1996 and 2013. The thesis examines how returns are impacted by: 1) stock market and commodity risk premia, 2) the time-varying nature of the risk premia and 3) liberalisation and decarbonisation objectives on the sector. More specifically, Chapter 4 develops an asset pricing model which is superior at explaining variation in energy utility returns compared with existing specifications. An inter-sectoral analysis shows that energy utilities’ returns are distinct to other sectors, including the oil & gas sector. The results also show inter-temporal variability in parameters. Chapter 5 addresses existing criticisms of asset pricing models, making adaptations to overcome poor performance at the sector level. The chapter also implements deductive and inductive structural break point tests, identifying significant break points in parameters and better isolates the unsystematic, firm-specific component of returns. Chapter 6 utilises the comprehensive asset pricing model developed in Chapter 5 to implement an event study approach surrounding key stages of the ordinary legislative procedure, examining the timing of market reaction and information incorporation. Further, Chapter 6 also explores how returns are impacted by four major policy streams, namely: Internal Energy Market, Energy Efficiency, Renewable Energies and Security of Supply streams. The findings are multiple and appeal to academics and policy-makers alike. The results show that energy utilities are increasingly exposed to market and commodity risk factors through time, with standard finance risk factors having a greater impact than commodities. The results also show previously undocumented heterogeneous return profiles across different utilities, subject to significant structural breaks. Overall, the Internal Energy Market and Energy Efficiency streams have a cross-sectional negative impact on energy sector returns and at an early stage of the legislative procedure, thereby affect the sectors’ ability to raise the estimated €2.2 trillion investment capital needed to transition to a ‘smart’, decarbonised energy system. The Renewable Energies and Security of Supply streams have a limited impact on sector returns

A qualitative assessment of health extension workers’ relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance

Background: Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between EWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services. Methods: We conducted a qualitative study in six districts in the Sidama zone, which included focus group discussions (FGDs) with HEWs, women and men from the community and semi-structured interviews with HEWs; key informants working in programme management, health service delivery and supervision of HEWs; mothers; and traditional birth attendants. Respondents were asked about facilitators and barriers regarding HEWs’ relationships with the community and health sector. Interviews and FGDs were recorded, transcribed, translated, coded and thematically analysed. Results: HEWs were selected by their communities, which enhanced trust and engagement between them. Relationships were facilitated by programme design elements related to support, referral, supervision, training, monitoring and accountability. Trust, communication and dialogue and expectations influenced the strength of relationships. From the community side, the health development army supported HEWs in liaising with community members. From the health sector side, top-down supervision and inadequate training possibilities hampered relationships and demotivated HEWs. Health professionals, administrators, HEWs and communities occasionally met to monitor HEW and programme performance. Expectations from the community and health sector regarding HEWs’ tasks sometimes differed, negatively affecting motivation and satisfaction of HEWs. Conclusion: HEWs’ relationships with the community and health sector can be constrained as a result of inadequate support systems, lack of trust, communication and dialogue and differing expectations. Clearly defined roles at all levels and standardized support, monitoring and accountability, referral, supervision and training, which are executed regularly with clear communication lines, could improve dialogue and trust between HEWs and actors from the community

Exploring providers’ perspectives of a community based TB approach in Southern Ethiopia: implication for community based approaches

Abstract Background There is increasing interest in the role of close-to-community providers in supporting universal health coverage, but questions remain about the best approaches to supporting and motivating these providers, and the optimal package they can deliver indifferent contexts and support required. We report on the experiences of different health providers involved in a community based intervention to support access to tuberculosis diagnosis and treatment in Southern Ethiopia. Methods The aim of the study is to explore the experiences of health providers in delivering a community-based tuberculosis package in southern Ethiopia and to draw lessons for community-based programmes. A qualitative methodology was used. Methods included in-depth interviews (IDIs, n= 37) with all health provider groups: Community health promoters (CHPs), health extension workers (HEWs), district supervisors and laboratory technicians were undertaken to obtain a detailed understanding of the experiences of providers in the community based tuberculosis package. These were complemented with cadre specific focus group discussions (n= 3). We used the framework approach for qualitative analysis. Results The key theme that emerged was the positive impact the community-based intervention had on vulnerable groups’ access to diagnosis, care and treatment for tuberculosis. Providers found the positive feedback from, and visible impact on, communities very motivating. Other themes related to motivation and performance included supervision and support; learning new skills; team problem solving/ addressing challenges and incentives. Against the backdrop of the Ethiopian Health Extension Programme (HEP), HEWs were successfully able to take on new tasks (collecting sputum and preparing smears) with additional training and appropriate support from supervisors, laboratory technicians and CHPs. Conclusion All categories of providers were motivated by the high visible impact of the community-based intervention on poor and vulnerable communities and households. HEWs role in the community-based intervention was supported and facilitated through the structures and processes established within the community-based intervention and the broader nation-wide Health Extension Programme. Within community based approaches there is need to develop context embedded strategies to support, sustain and motivate this critical cadre who play a pivotal role in linking health systems and rural communities

Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: a qualitative study

Background The Ethiopian TB control programme relies on passive case finding of TB cases. The predominantly rural-based population in Ethiopia has limited access to health facilities creating barriers to TB services. An intervention package aimed to bring TB diagnosis and treatment services closer to communities has been implemented through partnership with health extension workers (HEWs). They undertook advocacy, communication and social mobilization (ACSM) activities, identified symptomatic individuals, collected sputum, prepared smears and fixed slides at community level. Field supervisors supported HEWs by delivering smeared slides to the laboratory, feeding back results to the HEWs and following up smear-negative cases. Patients diagnosed with TB initiated treatment in the community, they were supported by supervisors and HEWs through the local health post. Case notification increased from 64 to 127/100,000 population/year. Methods This qualitative study assessed community members’ treatment seeking behaviour and their perceptions of the intervention. In-depth interviews (n=36) were undertaken with participants in six districts. Participants were clients of the community-based intervention, currently on TB treatment or those screened negative for TB. Transcripts were translated to English and a thematic analytical framework was developed guided by the different steps symptomatic individuals take within the intervention package. Coding was done and queries run using NVivo software. Results Prior to the intervention many patients with chronic cough did not access TB services. Participants described difficulties they faced in accessing district level health facilities that required travel outside their communities. Giving sputum samples and receiving results from within their home communities was appreciated by all participants. The intervention had a high level of acceptability; particularly clear benefits emerged for poor women and men and those too weak to travel. Some participants appeared to prefer a diagnosis of TB, this is likely because receiving a negative smear microscopy result brought further uncertainty and necessitated seeking further investigation. Conclusions There is evidence rural populations with high levels of poverty, and in particular women, are at high risk of unmet health needs and undiagnosed TB. Embedding TB services within communities was an acceptable approach for vulnerable groups experiencing poor access to health facilities. In the Ethiopian context this approach can facilitate early diagnosis and improve treatment outcomes

Sub-national prevalence survey of tuberculosis in rural communities of Ethiopia

Abstract Background Tuberculosis is a major public health problem with varying prevalence in different settings. National prevalence surveys provide evidence for planning and decision making. However, they lack the capacity to estimate subnational magnitude that affected the capacity to make selected intervention based on the prevalence. Ethiopia is among high TB burden countries with estimated prevalence of 108 per 100,000 population varying by regions. We aimed to study sub national prevalence of smear-positive TB in rural communities of southern Ethiopia. Methods This cross-sectional study, enrolled community members aged over 14 years who had cough of at least two weeks duration. Two sputum samples were collected and examined by using smear microscopy. Results 38,304 eligible people were enumerated (10,779 from Hadiya, 10,059 from Gurage and 17,466 from Sidama) and indentified 960 presumptive cases. 16, 14 and 14 smear-positive pulmonary TB cases were identified respectively. The point prevalence of smear-positive TB were 148 per 100,000 population (95% CI: 91–241) in Hadiya, 139 per 100,000 population (95% CI: 83–234) in Gurage and 80/100,000 population (95%CI: 48–135) in Sidama zone. Gurage zone had the highest prevalent to notified cases of seven to one. Conclusions The prevalence of smear positive TB varies by districts and is high in rural southern Ethiopia compared to the estimated national prevalence. More TB patients remain missed and unreached, impacting negatively on health outcomes. TB case finding approaches should be revisited and innovative approaches and tools to identify missing people with TB should be scaled up

Effective management of district-level malaria control and elimination: Implementing quality and participative process improvements

Although it is widely recognized that strong program management is essential to achieving better health outcomes, this priority is not recognized in malaria programmatic practices. Increased management precision offers the opportunity to improve the effectiveness of malaria interventions, overcoming operational barriers to intervention coverage and accelerating the path to elimination. Here we propose a combined approach involving quality improvement, quality management, and participative process improvement, which we refer to as Combined Quality and Process Improvement (CQPI), to improve upon malaria program management. We draw on evidence from other areas of public health, as well as pilot implementation studies in Eswatini, Namibia and Zimbabwe to support the proposal. Summaries of the methodological approaches employed in the pilot studies, overview of activities and an outline of lessons learned from the implementation of CQPI are provided. Our findings suggest that a malaria management strategy that prioritizes quality and participative process improvements at the district-level can strengthen teamwork and communication while enabling the empowerment of subnational staff to solve service delivery challenges. Despite the promise of CQPI, however, policy makers and donors are not aware of its potential. Investments are therefore needed to allow CQPI to come to fruition

Dopamine Signaling Is Essential for Precise Rates of Locomotion by C. elegans

Dopamine is an important neuromodulator in both vertebrates and invertebrates. We have found that reduced dopamine signaling can cause a distinct abnormality in the behavior of the nematode C. elegans, which has only eight dopaminergic neurons. Using an automated particle-tracking system for the analysis of C. elegans locomotion, we observed that individual wild-type animals made small adjustments to their speed to maintain constant rates of locomotion. By contrast, individual mutant animals defective in the synthesis of dopamine made larger adjustments to their speeds, resulting in large fluctuations in their rates of locomotion. Mutants defective in dopamine signaling also frequently exhibited both abnormally high and abnormally low average speeds. The ability to make small adjustments to speed was restored to these mutants by treatment with dopamine. These behaviors depended on the D2-like dopamine receptor DOP-3 and the G-protein subunit GOA-1. We suggest that C. elegans and other animals, including humans, might share mechanisms by which dopamine restricts motor activity levels and coordinates movement