Planning and Management of Cross-Sectoral Programs: Strategies to Address NCDs
01 Jan 2013-pp 217-235
TL;DR: In this article, the authors describe, analyze, and recommend approaches and technologies to improve the response to non-communicable diseases (NCDs) and risk factors, based on past experiences and new challenges especially for developing countries.
Abstract: This chapter intends to describe, analyze, and recommend approaches and technologies to improve the response to non-communicable diseases (NCDs) and risk factors, based on past experiences and new challenges especially for developing countries. The recommendations include key issues to design, implement, and evaluate population-based interventions addressing chronic NCDs, responding to questions such as the following: Why interventions addressing NCDs have not produced the expected results, especially in developing countries? What strategies and tools have contributed to the successful planning and implementation of effective interventions?
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TL;DR: In this paper, the authors conducted a review and synthesis of Indonesian tobacco-related legislation and regulations, and conducted interviews with tobacco control activists and academics to understand political will towards tobacco control regulations and the tobacco industry.
Abstract: Introduction Indonesia has a high smoking prevalence that has not diminished significantly since 1990. Considering this, we aim to summarise the existing national tobacco-related policy mix and explore markers of policy incoherence in tobacco control between 2014 and 2020. Methods We conducted (1) a review and synthesis of Indonesian tobacco-related legislation and regulations; (2) a systematic search and synthesis of related literature and news reporting; and (3) interviews with tobacco control activists and academics to understand political will towards tobacco control regulations and the tobacco industry. Results Indonesia’s existing tobacco-related policy mix lies across the president’s office, six national ministries and one independent agency. However, current responsibility lies primarily with four government ministries: Ministries of Health, Finance, Communication and Information, and Trade and Industry, with the Ministry of Finance most active. Evidence demonstrates that official interministerial collaboration was lacking from 2014 to 2020 and suggests that institutional will to introduce more effective tobacco control varies considerably between different arms of government. Discussion Political will differs according to ministerial mandates and priorities, fostering a fragmented policy approach and undermining the development of a coherent response. Without political will from the president or national parliament to create an overarching framework for tobacco control, either via ratification of the Framework Convention on Tobacco Control or another mechanism, there remains no formal impetus for intragovernmental cooperation. Nonetheless, this analysis reveals some government progress and ‘pressure points’ that advocates can focus on to promote tobacco control policies within the current policy mix.
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TL;DR: The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task and now the council has updated its guidance.
Abstract: Evaluating complex interventions is complicated. The Medical Research Council9s evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
8,896 citations
TL;DR: The incidence of dental caries will increase in the near future in many developing countries of Africa, as a result of growing consumption of sugars and inadequate exposure to fluorides, and the risk of periodontal disease and tooth loss may increase.
Abstract: Dental caries and periodontal diseases have historically been considered the most important part of the global burden of oral diseases. At present, the distribution and severity of oral diseases vary in different parts of the world and within the same country or region. Dental caries is still a major public health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. It is also a prevalent oral disease in several Asian and Latin American countries, while it appears to be less common and less severe in most African countries. It is expected, however, that the incidence of dental caries will increase in the near future in many developing countries of Africa, as a result of growing consumption of sugars and inadequate exposure to fluorides. The significant role of socio-behavioural and environmental factors in oral disease and health is demonstrated in a large number of epidemiological surveys. The current pattern of dental caries reflects primarily distinct risk profiles across countries (related to living conditions, lifestyles and environmental factors) and the implementation of preventive oral health systems. In some industrialized countries there has been a positive trend in the reduction of tooth loss among adults in recent years, though the proportion of edentulous persons in the elderly population is still high in some countries. In most developing countries, access to oral health services is limited and teeth are often left untreated or are extracted because of pain or discomfort. Tooth loss and impaired oral function are therefore expected to increase as a public health problem in many developing countries. Tooth loss in adult life may also be attributable to poor periodontal health. Severe periodontitis, which may result in tooth loss, is found in 5-15% of most populations. In industrialized countries, studies show that tobacco use is a major risk factor for adult periodontal disease. With the growing consumption of tobacco in many developing countries, the risk of periodontal disease and tooth loss may therefore increase. Oral cancer is closely related to the use of tobacco and excessive consumption of alcohol. The prevalence of oral cancer is particularly high among men, and is the eighth most common cancer worldwide. In south and central Asia, consumption of tobacco in various forms is particularly high, and cancer of the oral cavity ranks among the three most common types of cancer. Periodontal disease and tooth loss are also related to chronic diseases such as diabetes mellitus: the growing incidence of diabetes may further impact negatively on oral health of people in several developing countries. …
3,729 citations
TL;DR: In this article, the authors draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales.
Abstract: The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: (1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; (2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and (3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?
1,265 citations
TL;DR: In this paper, the role of frames and boundary management in processes of learning at different levels and time scales is investigated, based on conceptual considerations and empirical insights, suggest that the development of such institutional settings involves continued processes of social learning.
Abstract: Natural resources management in general, and water resources management in particular, are currently undergoing a major paradigm shift. Management practices have largely been developed and implemented by experts using technical means based on designing systems that can be predicted and controlled. In recent years, stakeholder involvement has gained increasing importance. Collaborative governance is considered to be more appropriate for integrated and adaptive management regimes needed to cope with the complexity of social-ecological systems. The paper presents a concept for social learning and collaborative governance developed in the European project HarmoniCOP (Harmonizing COllaborative Planning). The concept is rooted in the more interpretive strands of the social sciences emphasizing the context dependence of knowledge. The role of frames and boundary management in processes of learning at different levels and time scales is investigated. The foundation of social learning as investigated in the HarmoniCOP project is multiparty collaboration processes that are perceived to be the nuclei of learning processes. Such processes take place in networks or “communities of practice” and are influenced by the governance structure in which they are embedded. Requirements for social learning include institutional settings that guarantee some degree of stability and certainty without being rigid and inflexible. Our analyses, which are based on conceptual considerations and empirical insights, suggest that the development of such institutional settings involves continued processes of social learning. In these processes, stakeholders at different scales are connected in flexible networks that allow them to develop the capacity and trust they need to collaborate in a wide range of formal and informal relationships ranging from formal legal structures and contracts to informal, voluntary agreements.
1,135 citations
TL;DR: A radical departure from the way large scale interventions are typically conceptualised is proposed, which could liberate interventions to be responsive to local context and potentially more effective while still allowing meaningful evaluation in controlled designs.
Abstract: Complex interventions are more than the sum of their parts, and interventions need to be better theorised to reflect this
Many people think that standardisation and randomised controlled trials go hand in hand. Having an intervention look the same as possible in different places is thought to be paramount. But this may be why some community interventions have had weak effects. We propose a radical departure from the way large scale interventions are typically conceptualised. This could liberate interventions to be responsive to local context and potentially more effective while still allowing meaningful evaluation in controlled designs. The key lies in looking past the simple elements of a system to embrace complex system functions and processes.
The suitability of cluster randomised trials for evaluating interventions directed at whole communities or organisations remains vexed.1 It need not be.2 Some health promotion advocates (including the WHO European working group on health promotion evaluation) believe randomised controlled trials are inappropriate because of the perceived requirement for interventions in different sites to be standardised or look the same.1 3 4 They have abandoned randomised trials because they think context level adaptation, which is essential for interventions to work, is precluded by trial designs. An example of context level adaptation might be adjusting educational materials to suit various local learning styles and literacy levels.
Lead thinkers in complex interventions, such as the UK's Medical Research Council, also think that trials of complex interventions must “consistently provide as close to the same intervention as possible” by “standardising the content and delivery of the intervention.”5 By contrast, however, they do not see this as a reason to reject randomised controlled trials.
These divergent views have led to problems on two fronts. Firstly, the field of health promotion is being turned away from randomised …
1,016 citations