Population weighted raster maps can communicate findings of social audits: examples from three continents

Mobilising communities for Aedes aegypti control: the SEPA approach

Abstract

Camino Verde (the Green Way) is an evidence-based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases. Its effectiveness was demonstrated in a cluster-randomised controlled trial conducted in 2010–2013 in Nicaragua and Mexico. The common approach that brought functional consistency to the Camino Verde intervention in both Mexico and Nicaragua is Socialisation of Evidence for Participatory Action (SEPA).

In this article, we explain the SEPA concept and its theoretical origins, giving examples of its previous application in different countries and contexts. We describe how the approach was used in the Camino Verde intervention, with details that show commonalities and differences in the application of the approach in Mexico and Nicaragua. We discuss issues of cost, replicability and sustainability, and comment on which components of the intervention were most important to its success. In complex interventions, multiple components act in synergy to produce change. Among key factors in the success of Camino Verde were the use of community volunteers called brigadistas, the house-to-house visits they conducted, the use of evidence derived from the communities themselves, and community ownership of the undertaking.

Communities received the intervention by random assignment; dengue was not necessarily their greatest concern. The very nature of the dengue threat dictated many of the actions that needed to be taken at household and neighbourhood levels to control it. But within these parameters, communities exercised a large degree of control over the intervention and displayed considerable ingenuity in the process.

Trial registration

ISRCTN27581154.

Disability and health outcomes in geospatial analyses of Southeastern U.S. county health data

BACKGROUND

People with disabilities tend to be at risk for secondary conditions. There is a need for comprehensive disability and health databases, including geographic information systems to evaluate trends in health, functioning, and employment.

OBJECTIVE

We evaluated county levels in morbidity and mortality across the Southeastern United States using spatial regression, examining 2015 trends in accordance with Healthy People 2020 objectives.

METHODS

We merged 2015 National County Health Rankings and the 2015 Social Security Administration's Report on SSDI Beneficiaries, all for n = 1387 Southeastern U.S. county units. We used GeoDa to regress health and disability multivariable models for the dependent variable, age-adjusted Years of Potential Life Lost (YPLL) per 100,000 population.

RESULTS

The principal Health/Demographic multivariable model of factors impacting YPLL yielded an adjusted R² = 0.743 (F = 188.3, p < 0.001) with percentage physically inactive, preventable hospital stays, percentage diabetics, and low college attendance figuring prominently. A Socioeconomic/Demographic multivariable model impacting YPLL yielded R² = 0.631 (F = 156.0, p < 0.001), with disability and percentage unemployment being major associated variables.

CONCLUSIONS

For the Southeastern U.S., counties with higher prevalence of SSDI disability workers correlated with significantly higher YPLL and poorer health outcomes. The research augments CDC Disability and Health GIS systems to measure Healthy People 2020 outcomes for persons with disabilities nationwide. Spatial regression represents a robust approach for improved analysis of geographic data for population health measures.

Socio-economic determinants of ownership and use of treated bed nets in Nigeria: results from a cross-sectional study in Cross River and Bauchi States in 2011

Background

Poor people bear a disproportionate burden of malaria and prevention measures may not reach them well. A study carried out to examine the socio-economic factors associated with ownership and use of treated bed nets in Cross River and Bauchi States of Nigeria took place soon after campaigns to distribute treated bed nets.

Methods

A cross-sectional household survey about childhood illnesses among mothers of children less than four years of age and focus group discussions in 90 communities in each of the two states asked about household ownership of treated bed nets and their use for children under four years old. Bivariate and multivariate analyses examined associations between socio-economic and other variables and these outcomes in each state.

Results

Some 72% of 7,685 households in Cross River and 87% of 5,535 households in Bauchi State had at least one treated bed net. In Cross River, urban households were more likely to possess bed nets, as were less-poor households (enough food in the last week), those with a male head, and those from communities with a formal health facility. In Bauchi, less-poor households and those with a more educated head were more likely to possess nets. In households with nets, only about half of children under four years old always slept under a net: 54% of 11,267 in Cross River and 57% of 11,277 in Bauchi. Factors associated with use of nets for young children in Cross River were less-poor households, fewer young children in the household, more education of the father, antenatal care of the mother, and younger age of the child, while in Bauchi the factors were a mother with more education and antenatal care, and younger age of the child. Some focus groups complained of distribution difficulties, and many described misconceptions about adverse effects of nets as an important reason for not using them.

Conclusion

Despite a recent campaign to distribute treated bed nets, disadvantaged households were less likely to possess them and to use them for young children. Efforts are needed to reach these households and to dispel fears about dangers of using treated nets.

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study

Background

Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice.

Methods

A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed.

Results

Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change.

Conclusions

This study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.

Building the community voice into planning: 25 years of methods development in social audit

Health planners and managers make decisions based on their appreciation of causality. Social audits question the assumptions behind this and try to improve quality of available evidence. The method has its origin in the follow-up of Bhopal survivors in the 1980s, where "cluster cohorts" tracked health events over time. In social audit, a representative panel of sentinel sites are the framework to follow the impact of health programmes or reforms. The epidemiological backbone of social audit tackles causality in a calculated way, balancing computational aspects with appreciation of the limits of the science.Social audits share findings with planners at policy level, health services providers, and users in the household, where final decisions about use of public services rest. Sharing survey results with sample communities and service workers generates a second order of results through structured discussions. Aggregation of these evidence-based community-led solutions across a representative sample provides a rich substrate for decisions. This socialising of evidence for participatory action (SEPA) involves a different skill set but quality control and rigour are still important.Early social audits addressed settings without accepted sample frames, the fundamentals of reproducible questionnaires, and the logistics of data turnaround. Feedback of results to stakeholders was at CIET insistence--and at CIET expense. Later social audits included strong SEPA components. Recent and current social audits are institutionalising high level research methods in planning, incorporating randomisation and experimental designs in a rigorous approach to causality.The 25 years have provided a number of lessons. Social audit reduces the arbitrariness of planning decisions, and reduces the wastage of simply allocating resources the way they were in past years. But too much evidence easily exceeds the uptake capacity of decision takers. Political will of governments often did not match those of donors with interest conditioned by political cycles. Some reforms have a longer turnaround than the political cycle; short turnaround interventions can develop momentum. Experience and specialisation made social audit seem more simple than it is. The core of social audit, its mystique, is not easily taught or transferred. Yet teams in Mexico, Nicaragua, Canada, southern Africa, and Pakistan all have more than a decade of experience in social audit, their in-service training supported by a customised Masters programme.