Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link

Introduction: Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. Methods: A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. Results: Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5th-7th) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7th pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare. Conclusion: The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7th Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.

Post-war Sustainability-Driven School Buildings: A Review of the Literature

The Safe Schools Declaration of 2015 is an inter-governmental political agreement signed by several countries designed to protect the schooling of the school-aged population during armed conflicts.Yet,in countries where civil war erupted,schools were demolished.Several school-aged children were either forcibly recruited by governments or coerced by rebel groups to serve in armed fights.As a result,several children were deprived of their education and have remained suffering from deep psychological scars.The central question of the study is:What kind of sustainability-driven school buildings can be initiated in countries that are now enduring peace so that the learning environments are more comfortable and improve the well-being of the war-impacted children and school employees?After reviewing the literature,a strategic conceptual framework that incorporated the synergistic relationship between economic,social,and environmental aspects of sustainability was initiated to map out sustainable school buildings.In short,the conceptual framework proposed to construct school buildings in some of the war-affected developing countries includes assembling cost-efficiency and eco-effectiveness inputs,using renewable energy sources powered by natural sunlight,collecting rainwater in mud cisterns,reducing emissions of carbon oxides,and empowering the local community to be the main actors to design sustainable buildings during the preconstruction,construction,and post-construction stages to serve as learning spaces for the war-affected occupants and their neighborhoods.

A pattern for partnership between LMDH and Perhutani to enhance local community prosperity and preserve the forest:a case study at RPH Besowo,Kediri Regency,Indonesia

The deforestation in Indonesia is already alarming.One of the strategies used by the government to overcome forest deforestation is social forestry.This program is called PHBM(Pengelolaan Hutan Bersama Masyarakat/Joint Forest Management) which is basically a partnership program.This study aims at describing the partnership program between a local organization(i.e.LMDH) and a government unit(i.e.RPH of Perhutani) within the PHBM program.The objectives of this study are to(a) describe the model of partnerships between LMDH and RPH Besowo for sustainable forest management and local community empowerment;(b) determine the contribution of the forest to the national economy and rural household income;and(c) determine the obstacles commonly found in Besowo forest that have to be faced during the implementation of the partnerships.The study shows that with good partnership between these two units,the prosperity of the local community can be enhanced and the forest preservation can be maintained.The model of the partnerships in this particular area in Indonesia is expected to be applicable as well in other rural areas in Indonesia,as well as in other developing countries.

The practicality and sustainability of a community advisory board at a large medical research unit on the Thai-Myanmar border

Community engagement is increasingly promoted to strengthen the ethics of medical research in low-income countries. One strategy is to use community advisory boards (CABs): semi-independent groups that can potentially safeguard the rights of study participants and help improve research. However, there is little published on the experience of operating and sustaining CABs. The Shoklo Malaria Research Unit (SMRU) has been conducting research and providing healthcare in a population of refugees, migrant workers, and displaced people on the Thai-Myanmar border for over 25 years. In 2009 SMRU facilitated the establishment of the Tak Province Community Ethics Advisory Board (T-CAB) in an effort to formally engage with the local communities both to obtain advice and to establish a participatory framework within which studies and the provision of health care can take place. In this paper, we draw on our experience of community engagement in this unique setting, and on our interactions with the past and present CAB members to critically reflect upon the CAB’s goals, structure and operations with a focus on the practicalities, what worked, what did not, and on its future directions.

Integration of community health workers into health systems in developing countries:Opportunities and challenges

Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.

Intellectual Property Protection and High-quality Development of Cotton Industry in Xinjiang

This paper firstly introduces the general situation of cotton planting areas in China and cotton industry in Xinjiang,and the current situation of intellectual property protection of Xinjiang's cotton industry.Then,it analyzes the main problems in its intellectual property protection and high-quality development.On this basis,it comes up with the recommendations for high-quality development of cotton industry in Xinjiang under the strategy of strengthening the country with intellectual property.The recommendations include improving the level of creation of creative intellectual property rights,building an intellectual property rule system in the entire cotton industry chain in Xinjiang,building protected zones for production of major high quality agricultural product cotton,establishing a demonstration zone to undertake the transfer of the domestic cotton textile and garment industry,undertaking education on the sense of community for the Chinese nation in response to the Xinjiang cotton incident,and developing the"Belt and Road"blue market for Xinjiang cotton and its products.

Sustaining Increase in Life Expectancy in Africa Requires Active Preventive Measures against Non-Communicable Diseases

It is projected that aged population (≥60 years) will continue to increase globally, including in Africa. This is due to reduced population growth, decreased fecundity and improved medical interventions;factors which increase life expectancy. While this is typical for developed countries, it is not the same for Africa and similar developing regions. In these regions, a significant proportion of death is due to non-communicable diseases (NCD’s) such as hypertension, cerebrovascular accident, coronary heart disease, diabetes mellitus, chronic renal disease and cancer, among others. Rising prevalence of NCD’s due mainly to western style diets and sedentary living is made worse by inadequate nutrition education, high prevalence of low birth weight, poor health services, lack of efficient tobacco control and deficient planning of built environment. In order to halt the possible reduction in life expectancy occasioned by NCD’s, efforts by the community, health planners and governments in Africa to address relevant NCD’s, must be put in place. Suggested measures are: nutrition education, regular community directed physical exercise, improved environmental planning and development. Others are review of present health service model, early detection, prevention and treatment of NCD’s, including improved antenatal care to reduce low birth weights, and establishment of policies and measures that decreased access to tobacco especially by women of childbearing age. Africa and similar developing regions cannot fund the health bill due to NCD’s and their complications;hence it is important that this scourge is attended to with all seriousness.

Harmony in Diversity for Peaceful Progress

In the complicated world that we live in today, trust between different countries has seemingly been in jeopardy in the field of global governance. The Chinese civilization, since ancient times, has hailed mutual trust and understanding as something precious, and inspired its people to be responsible members of the global community.