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Item 10 years of the Syrian conflict: A time to act and not merely to remember [Comment](Elsevier, 2021-03-12) Jabbour, Samer; Leaning, Jennifer; Nuwayhid, Iman; Ager, Alastair; Cammett, Melani; Dewachi, Omar; Fouad, Fouad M.; Giacaman, Rita; Sapir, Debarati Guha; Hage, Ghassan; Majed, Ziad; Nasser, Rabie; Sparrow, Annie; Spiegel, Paul; Tarakji, Ahmad; Whitson, Sarah Leah; Yassin, NasserItem 100 key research questions for the post-2015 development agenda(ODI, 2015-12-13) Oldekop, Johan A.; Fontana, Lorenza B.; Grugel, Jean; Roughton, Nicole; Adu-Ampong, Emmanuel A.; Bird, Gemma K.; Dorgan, Alex; Vera Espinoza, Marcia; Wallin, Sara; Hammett, Daniel; Agbarakwe, Esther; Agrawal, Arun; Asylbekova, Nurgul; Azkoul, Clarissa; Bardsley, Craig; Bebbington, Anthony J.; Carvalho, Savio; Chopra, Deepta; Christopoulos, Stamatios; Crewe, Emma; Dop, Marie-Claude; Fischer, Joern; Gerretsen, Daan; Glennie, Jonathan; Gois, William; Gondwe, Mtinkheni; Harrison, Lizz A.; Hujo, Katja; Keen, Mark; Laserna, Roberto; Miggiano, Luca; Mistry, Sarah; Morgan, Rosemary J.; Raftree, Linda L.; Rhind, Duncan; Rodrigues, Thiago; Roschnik, Sonia; Senkubuge, Flavia; Thornton, Ian; Trace, Simon; Ore, Teresa; Valdés, René Mauricio; Vira, Bhaskar; Yeates, Nicola; Sutherland, William J.The Sustainable Development Goals (SDGs) herald a new phase for international development. This article presents the results of a consultative exercise to collaboratively identify 100 research questions of critical importance for the post-2015 international development agenda. The final shortlist is grouped into nine thematic areas and was selected by 21 representatives of international and non-governmental organisations and consultancies, and 14 academics with diverse disciplinary expertise from an initial pool of 704 questions submitted by 110 organisations based in 34 countries. The shortlist includes questions addressing long-standing problems, new challenges and broader issues related to development policies, practices and institutions. Collectively, these questions are relevant for future development-related research priorities of governmental and non-governmental organisations worldwide and could act as focal points for transdisciplinary research collaborations.Item 133 Integrating refugees into inclusive health financing systems(Oxford University Press (OUP), 2025-12-08) Mladovsky, Philipa; Bozorgmehr, Kayvan; Witter, Sophie; Bertone, Maria Paola; Severoni, SantinoWKS 15: Integrating refugees into inclusive health financing systems, B305 (FCSH), September 4, 2025, 13:30 - 14:30 Rationales and Purpose Integration of refugees and migrants into health systems is a global priority. Yet to date, the focus has been on health service integration, overlooking important technical and political considerations in the field of health financing. The workshop will (a) strengthen the competency of participants in understanding opportunities and challenges of refugee health financing integration and (b) identify areas for future research. We will build on a WHO Global evidence review on health and migration (GEHM) report (in press) and ongoing research in this field. Methods/Process of Workshop The seminar will establish shared conceptual frameworks and provide examples from the field. We will demonstrate that health financing functions and principles, such as pooling, equity and reducing fragmentation, align strongly with refugee and migrant integration. Evidence and lessons from recently completed scoping literature reviews on integrating refugees into health financing systems in Europe, as well as fragile and conflict-affected states, will be presented. Participants will be invited to draw on their experiences of successes and limitations of refugee health financing integration, provide policy insights, reflect on the applicability of the conceptual frameworks, and propose future research directions in this emerging field. Projected Learning Outcomes 1. Participants will learn about mechanisms for promoting financial sustainability, such as facilitating broader risk pools, effective purchasing of quality health care and enhancing transparency and accountability of health financing. 2.Groupwork will facilitate networking, collaboration and innovative, critical thinking among researchers and policymakers in the under-researched area of refugee health financing.Item 285 Strengthening health system financing in complex humanitarian contexts: analysis from Northwest Syria and its implications for other disrupted contexts [Abstract](Oxford University Press (OUP), 2025-12-01) Bou-Orm, Ibrahim; Ekzayez, Abdulkarim; Mazumdar, Sumit; Witter, Sophie; Fouad, FouadPTH 8: Miscellaneous 1, B304 (FCSH), September 5, 2025, 11:30 - 12:30 Aims In Northwest Syria, successive periods of protracted war and forced displacement have led to shifting, fragile, and donor-dependent health systems. Our study aims to contribute to actionable evidence on the optimal use of scarce financial resources to reduce fragmentation, increase resilience, and build sustainability in the context of Northwest Syria and similar areas which lack strong governance and/or state presence. Methods The study took a mixed methods case study approach, using data from (1) a desk review of key reports, agency publications, and relevant databases, (2) key informant interviews and (3) an expert meeting, including drawing on the expertise of the research group. These were analysed thematically and used to develop causal loop diagrams that capture the complexities of financing in this setting. Findings were then compared with international health financing guidance to probe how fit this guidance is for disputed areas and protracted emergency settings. Results We present a diagnostic of financing arrangements in Northwest Syria, using the framework of the WHO Health Financing Progress Matrix (HFPM), highlighting specific financing bottlenecks, especially around coordination across the multiple actors, and propose interventions to support sustainable health financing and system recovery. We also propose areas of adaptation of the framework to make it more suitable to these disrupted settings. Conclusions We highlight health financing challenges but also opportunities for system strengthening in northwest Syria. While specific, these challenges reflect features that are commonly found in other disrupted settings, so better understanding of their nature and how to address them is important for moving ahead with UHC globally. Suggested adaptations of the HFPM for complex emergency and disputed settings is also a contribution to the development of this important normative and measurement tool.Item 295 Health without borders: rethinking cross-border health systems for migrants and displaced communities(Oxford University Press (OUP), 2025-12-08) Than, Kyu Kyu; Bertone, Maria Paola; Chavez, Cesar Rodriguez; Fouad, Fouad; Bou-Orm, IbrahimWKS 24: Health Without Borders: Rethinking Cross-Border Health Systems for Migrants and Displaced Communities, B203 (FCSH), September 4, 2025, 16:00 - 17:00 Background and objectives State-centric health systems inherently fail vulnerable populations such as displaced people living in or across border regions, or those trapped between power borders. These systems, designed around national sovereignty and territorial governance, often neglect the transnational realities of migration, conflict, and displacement. As a result, millions of displaced populations in borderlands from Myanmar to Syria and the Mexico-Guatemala corridor remain caught in limbo, navigating complex humanitarian and political landscapes with limited access to essential health services. This roundtable will critically examine the conceptualization and practicality of cross-border health systems as an alternative to top-down, state-centric models. Workshop Plan The session will feature short presentations or reflections (5-7 minutes per speaker) from scholars working on cross-border health systems in Myanmar, Syria, Lebanon and the Mexico-Guatemala corridor, highlighting key challenges and innovations. A moderated discussion (20 minutes) will follow focusing on governance beyond state borders, decolonizing health system design, and the role of non-state actors in delivering care. Using a participatory approach, the session will then engage the audience through live polling throughout the session and reflections to capture diverse perspectives from the audience (30 minutes). The roundtable will conclude with a synthesis of key takeaways, offering policy recommendations and research priorities, aiming to advance research and practice towards health systems that prioritize people over borders. Main Messages A migrant-centred health system challenges traditional state-centric healthcare models, advocating for a paradigm shift towards inclusive, resilient, and cross-border approaches. The roundtable will identify challenges and opportunities to rethink and redesign health systems that are centred around the needs displaced populations in politically contested regions.Item 34 Gender Difference in the Association between Handgrip Strength and Cognitive Performance of Older Adults in Rural Malaysia(Oxford University Press, 2019-12-20) Moffat, Emily; Stephan, Blossom CM; Allotey, Pascale; Reidpath, DanielIntroduction Handgrip strength is an easy and safe measurement to evaluate the physical functioning of older adults. Lower hand grip strength is associated with cognitive decline, and can be used as an effective method for early detection of cognitive impairment. Objective This study aimed to evaluate the gender differences in association between hand grip strength and cognitive performance among older adults in rural Malaysia Methods This was a cross-sectional study done among 200 community dwelling older adults (100 men and 100 women) aged ≥ 50 years. The study was embedded in the ongoing longitudinal study of South East Asia Community Observatory (SEACO) in Segamat district of Johor, Malaysia. Data was collected by trained data collectors during home visits. Cognitive performance was assessed using Mini Mental State Examination (MMSE). Hand grip strength was measured using digital grip dynamometer. Results The mean age of study participants was 61.5 years (SD= 8.4). Women had lower mean hand grip strength (19.8, SD=5.6) compared to men (33.4, SD= 8.2). The mean MMSE score for women and men were 23 (SD= 4.5) and 25.1(SD=3) respectively. Cognitive impairment was detected in 26% of men and 21% of women. Hand grip strength showed positive association with MMSE score, among women (ß coefficient= 0.302, p<0.001), but not among men (p= 0.077). Hand grip strength was significantly association with MMSE score among women (ß coefficient=0.162, 95% CI = 0.026- 0.298; p=0.02) after controlling for age, level of education and body mass index. Conclusion The study shows that lower hand grip strength is associated with poor cognitive performance among women, while hand grip strength is not associated with cognitive performance among men.Item 4 Cuadras a la Redonda. Diagnóstico y perspectivas de las radios comunitarias de la Región Metropolitana(Instituto de la Comunicación e Imagen, Universidad de Chile, 2005) Rodríguez, Raúl; Vera Espinoza, MarciaLa radio comunitaria es un instrumento democratizador de las comunicaciones, en el proceso de generar relaciones que fortalezcan la identidad de lo propio, del entorno, el barrio o la comuna. Constituye, por tanto, una dimensión importante en el ejercicio del Derecho a la Comunicación y la Libertad de Expresión. El presente trabajo compila investigaciones exploratorias referidas a la acción local de las radios comunitarias, la ley de mínima cobertura y la evaluación de las radios comunitarias de Santiago, entre otras.Item 434 Towards a climate-resilient and inclusive health system: policy context and climate actions at subnational level in Nepal [Abstract](Oxford University Press (OUP), 2025-12-08) Bhatta, Bharat Raj; Regmi, Shophika; Joshi, Yadav; Rijal, Aney; Raven, Joanna; Witter, Sophie; Baral, Sushil; Baral, Sushil C.OP 24: Refugees and Asylum Seekers 2, B210 (FCSH), September 4, 2025, 14:45 - 15:45 Aims Nepal ranks as one of the most vulnerable countries to climate change, facing extreme weather events and health risks. Limited evidence exists on the understanding and capacity of local health systems regarding climate change and health. Thus, this study aimed to review current policies, explore stakeholders’ and community members’ understanding and assess the preparedness of local health systems to address climate change-related health risks. Methods We employed a mixed methods approach, including policy and literature review and qualitative data collection. This involved 24 key informant interviews with stakeholders in three municipalities of Lumbini, Karnali and Bagmati Provinces in Nepal. The informants were from the health, environment, infrastructure, agriculture, and?livestock sectors. We also conducted five focused group discussion?with community members. We analyzed the data thematically. Results Nepal has developed policies on climate resilience and adaptation, but they lack clear guidance on building a climate-resilient health system. The stakeholders at subnational level have limited awareness of these policies due to insufficient orientation. Climate change is not a priority in local health plans due to resource constraints and capacity issues, with a focus on response rather than preparedness. The health system showed low resilience to climate risks. Community findings showed that recurrent climate-induced displacement in riverine areas led to economic hardship, forced migration, and increased health disparities, including rising mosquito- mosquito-borne diseases and mental distress. Conclusions Despite the existence of federal policies, there is a gap in their translation at the local level, and local health systems are inadequately prepared for the evolving climate crisis. It is crucial to communicate these policies to subnational levels and support local health systems in strengthening preparedness. Further, urgent interventions such as sustainable flood protection, resilient housing, and inclusive health services are essential to address migration-related health inequities and ensure long-term community stability.Item 445 A community-based intervention to promote influenza vaccine uptake among East London minority ethnicity (ME) populations and persons with low income: randomised pilot and feasibility trial(Oxford University Press (OUP), 2025-12-08) Hindes, Iona; Chaudhry, Tahreem; Tum, Patricia; Alexandris, P; Brentnall, Adam; Gabe, R; Smethurst, Hector; Kielmann, Karina; Kunst, Heinke; Hargraeves, Sally; Campbell, Colin; Griffiths, Chris; Zenner, DominikOP 33: Diseases and Interventions 1, B304 (FCSH), September 5, 2025, 09:00 - 10:00 Aims Influenza vaccination among underserved groups remains lower than in general populations. We co-designed a multilingual patient engagement tool (PET) which included an interactive text-messaging and appointment booking tool. We aimed to determine the feasibility and practicality of the PET to inform the design for a subsequent trial of influenza vaccine uptake Methods We co-designed the PET with patients and healthcare workers and 1:1 randomised six general practices in East London. Participants were blinded to allocation; practice staff were not. Non-vaccinated non-dissenting participants from minority ethnicity (ME) and low-income populations were eligible for the study. The primary outcome was vaccination uptake up to 180 days after randomisation; ascertained through electronic health records. Results Excluding patients who dissented (10.1%), lacked valid contact details (12.9%) or other reasons (14.4%), we randomised 5903 patients, 2933 to the intervention group and 2970 to the control group. Three GP practices were randomised into early and late start respectively. The median age was 49y (IQR 37-63y), in a diverse population (Asian 53%, Black 17%, White 7.1%, Mixed 0.7%, Other 12%; Index of multiple deprivation (IMD) quintiles 1 and 2, 95%). Intervention delivery was 27.6%, and 20 patients (2.6%) booked a vaccination. 143/2494 (5.7%, CI 4.9-6.7%) patients in the intervention and 155/2537 (6.1%, CI 5.1-7.1%) patients in the control group were vaccinated (odds ratio 0.93; CI 0.73-1.19). Vaccination uptake amongst patients who booked a vaccination was 70%. Conclusions This pilot study supports the feasibility of components for a larger trial to assess the effectiveness of PETs to improve vaccination rates in ME groups and those living in high deprivation. Key learning includes improvements in the intervention implementation and timing, and improved outcome ascertainment. Greater coordination and support between sites and trial teams could lead to effective evaluation of PETs.Item 570 Approaching data collection in a liminal health system: engaging migrants and internally displaced communities along the Thailand–Myanmar border(Oxford University Press (OUP), 2025-12-08) La, Thazin; DiStefano, Lydia; Win, Hay Mar; Traill, Tom; Tartaggia, Julie; Bertone, Maria Paola; Witter, Sophie; Than, Kyu KyuEP2.4, e-Poster Terminal 2, September 4, 2025, 11:35 - 12:55 Aims People from Myanmar, are one of the most migrated and displaced population in the Southeast Asia region after its 2021 political turmoil. It is estimated that 70% of these migrants move to Thailand particularly along the Myanmar Thai eastern border. In this area, access to healthcare a significant challenge, addressed by a constellation of diverse stakeholders and actors. This study explores how researchers ethically approach data collection in politically sensitive and insecure border regions. Methods The research is part of the study on the liminal Health System along the Thailand–Myanmar border. Fieldwork was conducted in Mae Sot, Thailand, and Myawaddy, Myanmar—areas characterized by high mobility, political unrest, and under resourced health infrastructures. To ensure participant safety and data integrity, the researchers obtained ethical approval from international and border area ethical committees. Early consultations with community-based healthcare providers guided the proposal development and participant recruitment strategies. A stakeholder workshop was conducted to map the local health system and care-seeking pathways using case-based discussions. Participants were recruited for interviews with support from trusted service providers and were scheduled at times and locations chosen by the participants, with attention to personal safety and confidentiality. Following data collection, research findings were shared with stakeholders to verify accuracy and ensure the protection of participants from any harm. The research team finalized the findings by incorporating stakeholder’s feedback. This process also contributed to building and maintaining trust with the community. Results Engaging hidden populations required trust-based relationships, flexible recruitment strategies, and culturally sensitive communication. The dual ethical review process and partnerships with local actors played a critical role in managing risks and enhancing community acceptance. Conclusion Approaching, data collection in fragile settings necessitates ethical rigor, strategic stakeholder engagement, transparent practices and respectful collaboration for accessing and accurately representing the voices of marginalized communities.Item A cluster randomised trial to evaluate the effect of optimising TB/HIV integration on patient level outcomes: The merge- trial protocol(Elsevier, 2014-10) Kufa, T.; Hippner, P.; Charalambous, S.; Kielmann, Karina; Vassall, A.; Churchyard, G.; Grant, Alison D.; Fielding, K.Introduction We describe the design of the MERGE trial, a cluster randomised trial, to evaluate the effect of an intervention to optimise TB/HIV service integration on mortality, morbidity and retention in care among newly-diagnosed HIV-positive patients and newly-diagnosed TB patients. Design Eighteen primary care clinics were randomised to either intervention or standard of care arms. The intervention comprised activities designed to optimise TB and HIV service integration and supported by two new staff cadres-a TB/HIV integration officer and a TB screening officer-for 24 months. A process evaluation to understand how the intervention was perceived and implemented at the clinics was conducted as part of the trial. Newly-diagnosed HIV-positive patients and newly-diagnosed TB patients were enrolled into the study and followed up through telephonic interviews and case note abstractions at six monthly intervals for up to 18 months in order to measure outcomes. The primary outcomes were incidence of hospitalisations or death among newly diagnosed TB patients, incidence of hospitalisation or death among newly diagnosed HIV-positive patients and retention in care among HIV-positive TB patients. Secondary outcomes of the study included measures of cost-effectiveness. Discussion Methodological challenges of the trial such as implementation of a complex multi-faceted health systems intervention, the measurement of integration at baseline and at the end of the study and an evolving standard of care with respect to TB and HIV are discussed. The trial will contribute to understanding whether TB/HIV service integration affects patient outcomes.Item A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon(2020-03-30) Noubani, Aya; Diaconu, Karin; Ghandour, Lilian; El Koussa, Maria; Loffreda, Giulia; Saleh, ShadiBackground Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility.Item A comparison of health-related quality of life using the World Health Organization Quality of Life-BREF and 5-Level EuroQol-5 Dimensions in the Malaysian population.(2025-03-31) Liem, Andrian; Chih, Hui Jun; Velaithan, Vithya; Norman, Richard; Reidpath, Daniel; Su, Tin TinThis study aimed to describe and compare health-related quality of life (QoL) as measured by the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and the EuroQol-5 Dimensions (EQ-5D) among the Malaysian population, examining differences by sociodemographic characteristics including age, income, sex, ethnicity, educational level, and occupation. This cross-sectional study used data from 19,402 individuals collected as part of a health and demographic surveillance system survey conducted in the Segamat district of Malaysia in 2018-2019. Descriptive statistics and measures of central tendency were produced. Differences in QoL among demographic sub-groups were examined using the t-test and analysis of variance, while the correlations between the WHOQoL-BREF and EQ-5D were evaluated using Pearson correlation coefficients. Based on complete case analysis (n=19,129), the average scores for the 4 WHOQoL-BREF domains were 28.2 (physical), 24.1 (psychological), 12.0 (social relationships), and 30.4 (environment). The percentages of participants not in full health for each EQ-5D dimension were 12.8% (mobility), 3.1% (self-care), 6.9% (usual activities), 20.9% (pain/discomfort), and 6.8% (anxiety/depression). Correlations between the 4 WHOQoL-BREF domains and the 5 EQ-5D dimensions were relatively weak, ranging from -0.06 (social relationships with self-care and pain/discomfort; p<0.001) to -0.42 (physical with mobility; p<0.001). Although health-related QoL as measured by the WHOQoL-BREF and the EQ-5D are correlated, these 2 measures should not be considered interchangeable. The choice between them should be guided by the specific research questions and the intended use of the data.Item A Jordanian case study: the implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings(2008) Horn, Rebecca; Strang, AlisonThis case study describes the use of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings in Jordan. The fieldwork was carried out 17-27 August 2008 in Jordan and involved discussions with representatives of humanitarian organisations and UN agencies in Amman and Zarqa. This paper describes the ways in which the guidelines have been disseminated in Jordan and how they have 'added value' within the context of the Iraqi refugee crisis in Jordan. It also describes the factors that have hindered the full implementation of the guidelines.Item A Kenyan case study: implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings(2008) Horn, Rebecca; Strang, AlisonThis case study describes the use of the IASC Guidelines on Mental Health and Psychosocial Support in Kenya. The fieldwork was carried out 14-25 July 2008, and involved discussions with representatives of humanitarian organisations, UN agencies and government departments in Nairobi, Eldoret and Nakuru. It describes the ways in which the guidelines have been disseminated in Kenya, how they have 'added value' in that context, as well as the factors that have hindered the full implementation of the guidelines in Kenya.Item A multi-country phase 2 study to evaluate the suitcase lab for rapid detection of SARS-CoV-2 in seven Sub-Saharan African countries: Lessons from the field(Elsevier, 2023-03-03) Ceruti, Arianna; Dia, Ndongo; Bakarey, Adeleye Solomon; Ssekitoleko, Judah; Andriamandimby, Soa Fy; Malwengo-Kasongo, Padra; Ahmed, Rasheeda H.A.; Kobialka, Rea Maja; Heraud, Jean Michel; Diagne, Moussa Moise; Dione, Marie Henriette Dior; Dieng, Idrissa; Faye, Martin; Faye, Ousmane; Rafisandratantsoa, Jean Théophile; Ravalohery, Jean-Pierre; Raharinandrasana, Claudio; Randriambolamanantsoa, Tsiry H.; Razanajatovo, Norosoa; Razanatovo, Iony; Rabarison, Joelinotahina H.; Dussart, Phillipe; Kyei-Tuffuor, Louis; Agbanyo, Abigail; Adewumi, Olubusuyi Moses; Fowotade, Adeola; Raifu, Muideen Kolawole; Okitale-Talunda, Patient; Kashitu-Mujinga, Gracia; Mbelu-Kabongo, Christelle; Ahuka-Mundeke, Steve; Makaka-Mutondo, Anguy; Abdalla, Enas M.; Idris, Sanaa M.; Elmagzoub, Wisal A.; Ali, Rahma H.; Nour, Eman O.M.; Ebraheem, Rasha S.M.; Ahmed, Huda H.H.; Abdalla, Hamadelniel E.; Elnegoumi, Musab; Mukhtar, Izdihar; Adam, Muatsim A.M.; Mohamed, Nuha Y.I.; Bedri, Shahinaz A.; Hamdan, Hamdan Mustafa; Kisekka, Magid; Mpumwiire, Monica; Aloyo, Sharley Melissa; Wandera, Joanita Nabwire; Agaba, Andrew; Kamulegeya, Rogers; Kiprotich, Hosea; Kateete, David Patrick; Kadetz, Paul; Truyen, Uwe; Eltom, Kamal H.; Sakuntabhai, Anavaj; Okuni, Julius Boniface; Makiala-Mandanda, Sheila; Lacoste, Vincent; Ademowo, George Olusegun; Frimpong, Michael; Sall, Amadou Alpha; Weidmann, Manfred; Wahed, Ahmed Abd ElBackground : The COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings. Objectives : To validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries. Study design : In this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 minutes. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied. Results : Four sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay). Conclusion : Overall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.Item A new look: professionalization of NGOs in Kyrgyzstan(Taylor & Francis, 2014-09-12) Jailobaeva, KanykeyNon-governmental organizations (NGOs) in post-Soviet Kyrgyzstan have become visible players in the social and political scene. However, despite being portrayed as professional organizations in the literature, the professionalization of NGOs in Kyrgyzstan has been understudied. This article aims to rectify this gap. It presents and discusses the findings of a study analysing NGOs from an organizational perspective using semi-structured interviews with 45 NGOs, self-administered questionnaires with their leaders and employees, and observation of their working environment. The key conclusion is that the NGO sector can be described as semi-professional. NGOs use different tactics to achieve efficiency and effectiveness. However, they face such challenges as limited funding, high staff turnover and poor coordination. The article provides an account of the NGO sector by mapping it into professional and non-professional groups that can serve as a new benchmark for better understanding NGOs in Kyrgyzstan.Item A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health(BioMed Central, 2024-10-21) Ager, Alastair; Hermosilla, Sabrina; Schafer, Alison; Kestel, DévoraBackground: There is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative. Methods: This study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework. Results: Documentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees. Conclusions: The role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.Item A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis(Public Library of Science, 2024-02-12) Abredu, Juliet; Dwumfour, Catherine K.; Alipitio, Boo; Alordey, Mawusi; Dzomeku, Veronica Millicent; Witter, SophieThe achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of ‘free’ delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the ‘free’ delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.