(An item from the ISHN Member information service) An article in Issue #2, 2015 of Journal of Development Effectiveness examines the uphill struggle of aid effectiveness caused by the proliferation and fragmentation of aid projects. The authors suggest that " Aid fragmentation is one of the hindrances to aid effectiveness. As a main contributing factor, proliferated aids from the donor side have been pointed out. In this regard, we first examine the main factors for the donors’ proliferation and its links with the recipients’ fragmentation, which have been asked in several studies, but are revisited again with a comprehensive up-to-date data set. We also examine whether a recipient country is indeed going to get worse off through fragmented aid or, more directly, by proliferated aid. The main findings are (1) donors tend to proliferate their aid disbursement as their aid budget increases; (2) the recipients’ fragmentation is mainly due to the donors’ proliferation, and this has been prevalent since the early stage of aid history; (3) non-monotonicity is shown between aid fragmentation and growth, given that economies of scale is dominant in the incipient stage of a recipient country’s growth, but turns out to affect negatively in the long run; (4) therefore, the donors’ proliferation will eventually harm the recipients’ growth. Read more>>
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(From the ISHN Member information service) In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.
A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community. For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence. The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors." The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level." The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem." Read more>> The report notes that "Vaccines and immunization have created a healthier world. Progress is being made towards polio eradication. Measles and neonatal tetanus deaths are on the decline and new vaccines are being
introduced into the national programmes of low -and middle-income countries with associated reductions in morbidity and mortality. Still, national governments, development partners and international agencies must invest more to meet the Decade of Vaccines’ goals of disease eradication or elimination and to reduce mortality and morbidity from vaccine-preventable diseases. However, the report also notes that :
(An item from the ISHN Member information service) An article in Issue #3, 2013 of Rural & remote Health reports on the effective use of a national school health assessment tool in Niger. "Award schemes and self-evaluation systems have been developed the HPS concept in European and Asian countries. However, the implementation of HPS in African countries has been minimal. This study evaluated the impact of a self-evaluation system on school health in Niger. A school health assessment guide was distributed to 1999 primary schools in the NigerTahoua region to raise awareness and solve problems related to school health and hygiene. The number of schools that planned or implemented health-related activities, and the budget and implementation status of their activities was compared over 3 years (before, soon after, and 1 year after distribution). Focus group discussions (FGDs) were also conducted targeting Conseillers Pédagogiques (CPs), who supervise primary schools and teachers, primary school principals and members of Comité de Gestion des Etablissement Scolaire (COGES), which is a type of school steering committee. The number of schools planning at least one activity increased from 47% to 79% soon after distribution of the guide.The number of schools implementing activities increased from 44% to 65% one year after distribution. Health-related budget per school also increased and increases were maintained 1 year after the intervention. Most FGD participants expressed a positive impression of the program and noted the usefulness of the guide. However, some respondents reported difficulties, especially in relation to budget. Conclusion: The introduction of a health activity guide for self-assessment was effective in increasing health-related activities in primary schools in Niger, where a simple monitoring system should be introduced to establish the HPS concept. Read more>>
(An item from the ISHN Member information service) A book review in Issue #2, 2013 of the Journal of Children and Poverty alerts us to an -in-depth analysis of development statistics in sub-Saharan Africa. The book chronicles how pressure from donor countries and international agencies has caused government officials in those countries to cobble together and mis-use several sources of data to draw inaccurate pictures of progress in these countries. Read more>>
(An item from the ISHN Member information service) A systematic review of over 700 studies of programs to reduce adolescent child bearing in low and middle income countries, published in issue #4, 2013 of Studies in Family Planning, reports that "A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing-related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school-based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted." Read more>>
(An item from the ISHN Member information service) An article in Issue #6, 2013 of the American Journal of Tropical Diseases & Hygiene describes the contributions of non-governmental organizations to WHO targets for control of soil-transmitted helminthiases. The authors note that Soil-transmitted helminthiases (STH) may affect up to 1 billion children globally. They estimate that "In 2010, NGOs delivered 65.4 million STH treatments, which is an estimated 25.1% of the total delivered. Of these treatments, 23.3 million (35.6%) were not reported to the WHO; 22.3 million (95.7%) were from countries that had not submitted STH treatment reports to the WHO. Read more>>
(From USAID) At USAID, we recognize that – for the first time in history – a world without extreme poverty is possible. This is an ambitious challenge: to lift more than 1 billion people out of extreme poverty. But we have built a solid foundation. USAID and the international community have improved economic opportunity, health, food security, education, equality, stability, and accountable governance for millions of people. In fact, nearly 700 million people have moved above the $1.25 per day poverty line since 1990. If we continue on this trajectory, we could reach zero by 2030. Read more>>
(An item from the ISHN Member information service) A systematic review of school and community-based mental health programs in low and middle countries was reported in the September 2013 o=issue of BMC Public Health. The reviewers report that of the 22 studies selected for the review "With regard to the school-based interventions, the quality of evidence from the 14 studies is moderate to strong. Findings indicate that there is reasonably robust evidence that programmes implemented across diverse LMICs can have significant positive effects on students’ emotional and behavioural wellbeing, including reduced depression and anxiety and improved coping skills. Promising interventions include the Resourceful Adolescent Program (RAP-A), delivered by teachers in Mauritius. This study is an example of an evidence-based intervention adapted from a HIC. Another promising intervention is the teacher led peer-group support intervention for AIDs orphaned children. This study suggests the potential of peer support mental health promotion interventions in optimizing adjustment and decreasing the psychological distress associated with AIDS orphanhood. Such interventions may have great potential in addressing the increased risk of depression, peer relationship problems, post-traumatic stress and conduct problems. There is also some encouraging evidence that interventions which combine lifeskills with reproductive and sexual health education and physical health and fitness can have a significant positive effect on pupils’ risk-taking and prosocial behaviour. These findings are consistent with the substantive evidence from multiple reviews of school-based interventions in HICs which report the greater effectiveness of multi-component interventions (i.e. interventions that adopt a social competence approach and develop supportive environments), when compared with interventions that focus on specific problem behaviours". Read more>>
(An item from the ISHN Member information service) An article in the September 2013 Issue of Public Health Nutrition documents the value of a low-cost snack provided in a school-feeding programs in Kenyan school children. The study compared three types of snacks and found that "The Meat and Plain Githeri (i.e. githeri + oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time." Read more>>
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