Community-based strategies to strengthen men's engagement in the HIV care cascade in sub-Saharan Africa

Monica Sharma and colleagues discuss evidence-based approaches to improving HIV services for men in sub-Saharan Africa.

Greening healthcare at Muskoka Algonquin Healthcare

Waste diversion is fundamental to reducing the ecological footprint. Until 2012, waste generated by Muskoka Algonquin Healthcare (MAHC) was not incorporated into any formal waste diversion efforts. In 2012, the Reduce, Recycle, Waste Diversion Program was initiated. Support for the program was endorsed by the senior leadership team, staff, and the community, and incorporated into the strategic plan, which was instrumental in the program's success. The goal of the waste diversion program was to help MAHC work towards a sustainable future and make MAHC a leading hospital in making responsible environmental choices. By increasing the number of recycle stations at MAHC's two hospital sites and providing education and promotion on the importance of waste diversion, MAHC has been successful in reducing the amount of waste going to the landfill to a 48% level between 2012 and 2015. The following case study illustrates and discusses MAHC's successful waste diversion efforts.

Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning by malaria control programmes in sub-Saharan Africa

BACKGROUND

Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning.

METHODS

Nested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5-14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2-9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016-2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria.

RESULTS

In projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts.

DISCUSSION

Spectrum-Malaria's user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module's linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.

[The Ottawa Charter: 30 years without an action plan?]

<ce:para>The Ottawa Charter is not an action plan, but rather a consensus document on the values and principles that should drive public health practice. It also provides, in the form of 5&#160;lines of action, a map of the determinants of population health. In this paper, based on the lecture I&#160;delivered at the Universit&#233; d&#8217;&#233;t&#233; francophone en sant&#233; publique de Besan&#231;on, I&#160;describe my vision of the Charter, what we have done with it and why it is about time we move on to operationalization of the project it embodies.</ce:para>.

Developing Governance Structures in Health Care System Consolidation: A Framework for Nurse Leaders

Given the acceleration and increasing complexity of integrative care models across health systems, the question how governance and management structure(s) should be operationalized and evolved to achieve peak system performance is paramount. In a recent evaluation of partnerships with the University of Kentucky HealthCare (UK HealthCare), the conceptualization of the integration management model was explored. It was recognized that nursing leadership, governance structure, and relationships are vital for successful movement and migration of appropriate care models. In this case, the evolving governance models and the forecasted impact on models of care delivery were carefully considered. This included the potential impact on nursing practice. As the model was developed, a conceptual framework was utilized to examine potential variant relationship arrangements and to provide organization to key constructs. Utilization of a blueprint to optimize decision making and provide a replicable approach was essential to management of the integration philosophy.

Impact on Epidemic Measles of Vaccination Campaigns Triggered by Disease Outbreaks or Serosurveys: A Modeling Study

BACKGROUND

Routine vaccination supplemented by planned campaigns occurring at 2-5 y intervals is the core of current measles control and elimination efforts. Yet, large, unexpected outbreaks still occur, even when control measures appear effective. Supplementing these activities with mass vaccination campaigns triggered when low levels of measles immunity are observed in a sample of the population (i.e., serosurveys) or incident measles cases occur may provide a way to limit the size of outbreaks.

METHODS AND FINDINGS

Measles incidence was simulated using stochastic age-structured epidemic models in settings conducive to high or low measles incidence, roughly reflecting demographic contexts and measles vaccination coverage of four heterogeneous countries: Nepal, Niger, Yemen, and Zambia. Uncertainty in underlying vaccination rates was modeled. Scenarios with case- or serosurvey-triggered campaigns reaching 20% of the susceptible population were compared to scenarios without triggered campaigns. The best performing of the tested case-triggered campaigns prevent an average of 28,613 (95% CI 25,722-31,505) cases over 15 y in our highest incidence setting and 599 (95% CI 464-735) cases in the lowest incidence setting. Serosurvey-triggered campaigns can prevent 89,173 (95% CI, 86,768-91,577) and 744 (612-876) cases, respectively, but are triggered yearly in high-incidence settings. Triggered campaigns reduce the highest cumulative incidence seen in simulations by up to 80%. While the scenarios considered in this strategic modeling exercise are reflective of real populations, the exact quantitative interpretation of the results is limited by the simplifications in country structure, vaccination policy, and surveillance system performance. Careful investigation into the cost-effectiveness in different contexts would be essential before moving forward with implementation.

CONCLUSIONS

Serologically triggered campaigns could help prevent severe epidemics in the face of epidemiological and vaccination uncertainty. Hence, small-scale serology may serve as the basis for effective adaptive public health strategies, although, in high-incidence settings, case-triggered approaches are likely more efficient.

Bottleneck analysis and strategic planning using Tanahashi model for childhood diarrhea management in Gujarat, Western India

In spite of continued efforts, India is still lagging behind in achieving its MDG goals. The objectives of this study were to identify stake-holders who have a role to play in childhood diarrhea management, to identify gaps in childhood diarrhea management and to propose strategic options for relieving these gaps. Bottleneck analysis exercise was carried out based on the Tanahashi model in six High Priority Districts (HPDs) of Gujarat in period between July-November 2013. The major bottlenecks identified for Childhood Diarrhea management were poor demand generation, unsafe drinking water, poor access to improved sanitation facility and lack of equitable distribution and replenishment mechanisms for Oral Rehydration Solution (ORS) packets and Zinc tablets till the front-line worker level. The main strategic options that were suggested for relieving these bottlenecks were Zinc-ORS roll out in scale-up districts, develop Information Education Communication/Behaviour Change Communication (IEC/BCC) plan for childhood diarrhea management at state/district level, use of Drug Logistics Information Management System (DLIMS) software for supply chain management of Zinc-ORS, strengthening of chlorination activity at household level, monitoring implementation of Nirmal Bharat Abhiyaan (NBA) for constructing improved sanitation facilities at household level and to develop an IEC/BCC plan for hygiene promotion and usage of sanitary latrines. Use of Zinc tablets need to be intensified through an effective scale-up. Adequate demand generation activity is needed. There is need to address safe drinking water and improved sanitation measures at household levels. Multi-sectoral engagements and ownership of Zinc-ORS program is the need of the hour.

Transforming a municipal school sports programme through a critical communicative methodology: The role of the of advisory committee

This research applies a communicative methodology (CM) to the transformation and improvement of the Municipal Comprehensive School Sports Programme in Segovia, Spain (MCSSP), using egalitarian dialogue, based on validity rather than power claims to achieve intersubjectivity and arrive at consensus between all of the Programme's stakeholders through the intervention of an advisory committee (AC). The AC is a body comprising representatives of all stakeholder groups involved in the programme. During the 2013-2014 academic year the programme's AC met four times, operating as a communicative focus group (CFG). The meetings focused on: (1) excluding dimensions (barriers preventing transformation) and transforming dimensions (ways of overcoming barriers), (2) the programme's strengths, (3) the programme's weaknesses and specific actions to remedy them, and (4) the resulting conclusions which were then incorporated into the subsequent programme contract signed between the University and the Segovia Local Authority for 2014-2018. The key conclusions were: (1) the recommendations of the AC widen the range of perspectives and help the research team to make key decisions and (2) the use of CM to fully evaluate the programme and to reach a consensus on how to improve it proved very valuable.

A Roadmap for Strategic Planning in the Healthcare Practice

The days of a practice putting up a shingle or sign and waiting for patients to come for treatment are over. The same applies to hospitals, which can't just have beds, an emergency department, an operating room, and an intensive care unit and hope to remain profitable in this tumultuous era of healthcare delivery. Now it is imperative to have a strategic plan to move forward. Practices and hospitals need a plan in order to prosper, rather than settle for mere survival. This article defines strategic planning, discusses the creation of a strategic plan, and lays out how a plan might be implemented in a medical practice or hospital.

Strategic Planning: A Practical Primer for the Healthcare Provider: Part II

Entrepreneurs are known for recognizing opportunity-that is "How can I start a business to make money from this opportunity?" However, once a commer- cial entity is formed to take advantage of an opportunity, the leadership prior- ity shifts from entrepreneurial to strategic. A strategic perspective leverages limited resources to position a business for future success relative to rivals in a competitive environment. Often, the talents needed to be a good entrepreneur are counter to those needed to be a good strategist. In Part I of this article, we presented the internal considerations; in this part we add the external consider- ations and then summarize the strategic plan.

Responding to change in a challenging climate: 2015 five-year report of the Policy and Planning Board

The American Psychological Association (APA) Bylaws Article XI.7 (http://www.apa.org/about/governance/bylaws/article-11.aspx) requires that the Policy and Planning Board report annually by publication to the membership and review the structure and function of the association as a whole every fifth year. This report details the board's 5-year review, including APA's challenges and achievements from 2011 through 2015 within the context of broader social and environmental changes. Recommended priorities for future change are offered. (PsycINFO Database Record

Advances and Future Directions for Tuberous Sclerosis Complex Research: Recommendations From the 2015 Strategic Planning Conference

On March 10 to March 12, 2015, the National Institute of Neurological Disorders and Stroke and the Tuberous Sclerosis Alliance sponsored a workshop in Bethesda, Maryland, to assess progress and new opportunities for research in tuberous sclerosis complex with the goal of updating the 2003 Research Plan for Tuberous Sclerosis (http://www.ninds.nih.gov/about_ninds/plans/tscler_research_plan.htm). In addition to the National Institute of Neurological Disorders and Stroke and Tuberous Sclerosis Alliance, participants in the strategic planning effort and workshop included representatives from six other Institutes of the National Institutes of Health, the Department of Defense Tuberous Sclerosis Complex Research Program, and a broad cross-section of basic scientists and clinicians with expertise in tuberous sclerosis complex along with representatives from the pharmaceutical industry. Here we summarize the outcomes from the extensive premeeting deliberations and final workshop recommendations, including (1) progress in the field since publication of the initial 2003 research plan for tuberous sclerosis complex, (2) the key gaps, needs, and challenges that hinder progress in tuberous sclerosis complex research, and (3) a new set of research priorities along with specific recommendations for addressing the major challenges in each priority area. The new research plan is organized around both short-term and long-term goals with the expectation that progress toward specific objectives can be achieved within a five to ten year time frame.

From local development policies to strategic planning-Assessing continuity in institutional coalitions

In the last two decades, EU policies have had a fundamental role in orienting regional/local development. The objective of this work is set in this context as it intends to analyze the local development programs activated in Sicily in the last three programming periods. The main aim is to explore whether the EU partnership principle influenced cooperation among local actors, assessing the continuity of local institutional coalition in managing different local development programs within the regional development policy system. We focus, in particular, on Strategic Plans (SP) promoted in Sicily in the transition phase between the 2000-2006 and the 2007-2013 periods.

Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: a single medical school experience

PURPOSE

In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges.

METHODS

Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease.

RESULTS

The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students.

CONCLUSION

Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.

Reserve network planning for fishes in the middle and lower Yangtze River basin by systematic conservation approaches

Although China has established more than 600 wetland nature reserves, conservation gaps still exist for many species, especially for freshwater fishes. Underlying this problem is the fact that top-level planning is missing in the construction of nature reserves. To promote the development of nature reserves for fishes, this study took the middle and lower reaches of the Yangtze River basin (MLYRB) as an example to carry out top-level reserve network planning for fishes using approaches of systematic conservation planning. Typical fish species living in freshwater habitats were defined and considered in the planning. Based on sample data collected from large quantities of literatures, continuous distribution patterns of 142 fishes were obtained with species distribution modeling and subsequent processing, and the distributions of another eleven species were artificially designated. With the distribution pattern of species, Marxan was used to carry out conservation planning. To obtain ideal solutions with representativeness, persistence, and efficiency, parameters were set with careful consideration regarding existing wetland reserves, human disturbances, hydrological connectivity, and representation targets of species. Marxan produced the selection frequency of planning units (PUs) and a best solution. Selection frequency indicates the relative protection importance of a PU. The best solution is a representative of ideal fish reserve networks. Both of the PUs with high selection frequency and those in the best solution have low proportions included in existing wetland nature reserves, suggesting that there are significant conservation gaps for fish species in MLYRB. The best solution could serve as a reference for establishing a fish reserve network in the MLYRB. There is great flexibility for replacing selected PUs in the solution, and such flexibility facilitates the implementation of the solution in reality in case of unexpected obstacles. Further, we suggested adopting a freshwater management framework in the implementation of such solution.