scholarly journals Challenges to Operationalizing Sustainable Diets: Perspectives From Kenya and Vietnam

2021 ◽  
Vol 5 ◽  
Author(s):  
Lesli Hoey ◽  
Colin K. Khoury ◽  
Jamleck Osiemo ◽  
Anna Shires ◽  
Brenda Binge ◽  
...  
Keyword(s):  
Food Systems ◽  
Change Agents ◽  
Project Managers ◽  
Decision Makers ◽  
National Guidelines ◽  
Institutional Barriers ◽  
Middle Income ◽  
Sustainable Diets ◽  
Middle Income Countries ◽  
Sector Data

Despite the urgent need for comprehensive food systems strategies, the challenge lies in defining feasible, evidence-based intervention points. Too little is known about issues food systems decision-makers and other change agents are running up against, particularly in low- and middle-income countries where food systems are the most vulnerable to a growing number of intertwined crises. We look at this question through the lens of sustainable diets, a growing area of research and a concept that is the basis of over 30 sets of national guidelines that aim to simultaneously address health, economic and environmental dimensions of food systems. Based on 114 interviews carried out in Kenya and Vietnam, we examine the extent to which food systems researchers, business and project managers and policy actors are attempting to intervene in food systems in ways that mirror the concept of sustainable diets. We also consider how they are managing two key ingredients that are critical to systems-change—interdisciplinary data and cross-sector collaboration. Most stakeholders we interviewed were carrying out systems-based projects, oriented—even if not explicitly—around many of the sustainable diets domains: agriculture, livelihoods, food security/access/nutrition and/or environment. The majority faced formidable challenges with both data and collaborations, however, showing why it can be so difficult to move from normative ideals like “sustainable diets” to practical realities, regardless of the context. To support more comprehensive food systems policies and interventions, our findings suggest the need for strategies that can improve the collection and accessibility of actionable, cross-sector data, and mechanisms to overcome institutional barriers that limit collaboration.

scholarly journals COST, CONTEXT, AND DECISIONS IN HEALTH ECONOMICS AND HEALTH TECHNOLOGY ASSESSMENT

2018 ◽  
Vol 34 (5) ◽  
pp. 434-441 ◽  
Author(s):  
Anthony J. Culyer
Keyword(s):  
Health Economics ◽  
Health Technology Assessment ◽  
Decision Maker ◽  
Technology Assessment ◽  
Health Technology ◽  
Decision Makers ◽  
Negative Consequences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Context Dependent

Objectives:This study is an attempt to demystify and clarify the idea of cost in health economics and health technology assessment (HTA).Methods:Its method draws on standard concepts in economics. Cost is a more elusive concept than is commonly thought and can be particularly elusive in multidisciplinary territory like HTA.Results:The article explains that cost is more completely defined as opportunity cost, why cost is necessarily associated with a decision, and that it will always vary according to the context of that decision: whether choice is about inputs or outputs, what the alternatives are, the timing of the consequences of the decision, the nature of the commitment to which a decision maker is committed, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short and long runs and between fixed and variable inputs are matters of choice, not technology, and are similarly context-dependent. Harms or negative consequences are, in general, not costs. Whether so-called “clinically unrelated” future costs and benefits should be counted in current decisions again depends on context.Conclusions:The costs of entire health programs are context-dependent, relating to planned rates of activity, volumes, and timings. The implications for the methods of HTA are different in the contexts of low- and middle-income countries compared with high-income countries, and further differ contextually according to the budget constraints (fixed or variable) facing decision makers.

scholarly journals The Importance of a Food Systems Approach to Low and Middle Income Countries and Emerging Economies: A Review of Theories and Its Relevance for Disease Control and Malnutrition

2021 ◽  
Vol 5 ◽  
Author(s):  
Pablo Alarcon ◽  
Paula Dominguez-Salas ◽  
Eric M. Fèvre ◽  
Jonathan Rushton
Keyword(s):  
Public Health ◽  
Food Safety ◽  
Emerging Economies ◽  
Food Systems ◽  
Food System ◽  
Systems Science ◽  
Multidisciplinary Teams ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Our review explores the changing food production, distribution and consumption environment in low and middle-income countries and emerging economies as a basis for framing how to study food systems in order to address public health issues of food safety and nutrition. It presents the state of knowledge on existing food systems science and its use in terms of sustainable actions for food safety and public health. The review identifies a knowledge gap in food system mapping and governance, with value chain mapping of key commodities often missing. Despite a number of initiatives, the application of food systems methods is highly variable in scope and quality. Most analyses concentrate on specific commodities, rarely taking into account the need for a whole diet approach when looking at nutrition or the assessment of a range of infectious agents and their interactions when looking at food safety. Of the studies included in the review there is a growing observation of “informal” food systems, a term used inconsistently and one that requires revision. “Informal” food systems link to the formal sector to provide food security, yet with trade-offs between economic efficiencies and food safety. Efforts to improve food safety are hampered by inadequate food safety capacities and a lack of policy coherence leading to: inadequate investment; fragmented food quality control systems; weak or non-existent traceability mechanisms; weak foodborne disease surveillance; obsolete food regulation; and weak regulatory enforcement. In-depth food systems assessments can complement risk analysis to identify risky behaviors and understand institutional settings in order to improve codes of practice and enforcement. Methods for looking at food safety from a food systems perspective are emerging, yet existing nutrition and food systems science are not advancing sufficiently in response to nutritional public health problems. There is an urgency for improved understanding of the structure and drivers of the food systems, for better planning of changes that leads to nutrients access and healthy levels of eating. It is proposed that countries and international institutions provide an atlas of food system maps for the key commodities based on an agreed common methodology and developed by multidisciplinary teams.

scholarly journals Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) - the cost evaluation of life-style related NCD interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Koot
Keyword(s):  
Scaling Up ◽  
Decision Makers ◽  
Cost Evaluation ◽  
Health Coverage ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Gains ◽  
The Cost ◽  
Universal Health

Abstract Vietnam, Myanmar, and Indonesia are trying to create innovative synergies within and between sectors to prevent and treat NCDs. Universal Health Coverage (UHC) is the objective of these countries. The challenge for decision makers in healthcare is to implement programmes and interventions that effectively contain NCDs at the lowest possible cost both in community-based and primary care facilities. The value of implementation and upscaling is assessed by estimating costs, savings and health gains. The presentation focuses on cost-effectiveness evaluation of the entire scaling-up, allowing for comparison within and among countries and generate recommendations for achieving UHC in low- and middle-income countries.

scholarly journals Donation of Contraceptive Products through Special Import Permits: A Case Study in Zambia and Nigeria

2020 ◽  
Vol 8 (4) ◽  
pp. 55-60
Author(s):  
Courtney Stachowski ◽  
Noxolo Magubane ◽  
Mbavhalelo Jade Tshikosi ◽  
Wilberto Robles
Keyword(s):  
Case Description ◽  
National Guidelines ◽  
Viable Option ◽  
Middle Income ◽  
Middle Income Countries ◽  
Permit Application ◽  
Application Requirements ◽  
Formal Product ◽  
Contraceptive Product

Introduction: Securing a special import permit for the donation of an unregistered contraceptive product can be a viable option to import the product in an expedited manner. However, this process can be difficult due to varying country requirements and the availability of accurate and timely information. Case description: This paper will explore the process for securing import permits for donated contraceptive products in Zambia and Nigeria, comparing national guidelines to applicant experiences and providing recommendations to future applicants. Discussion and evaluation: In practice, application requirements and timelines for special import permits in Zambia and Nigeria differed from national guidelines. Despite these differences, special import permits can be secured more quickly than formal product registration, which is a slower but more sustainable solution. Conclusion: Due to a lack of comprehensive and up-to-date guidelines online for some low- and middle-income countries (LMICs), the regulatory community is encouraged to share their experiences with special import permit application processes.

scholarly journals Food Systems After Covid-19

IDS Bulletin ◽  
2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ayako Ebata ◽  
Nicholas Nisbett ◽  
Stuart Gillespie
Keyword(s):  
Supply Chain ◽  
Food Systems ◽  
Small And Medium Enterprises ◽  
Food Supply Chain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Nutrition Security ◽  
Food And Nutrition ◽  
Medium Enterprises ◽  
Local Innovation Systems

Measures to slow down the spread of Covid-19 have had profound effects on the food and nutrition security of poor and marginalised households and communities. This article provides an overview of the effects of Covid-19 on food systems across low- and middle-income countries using resilience and political economy lenses, before proposing approaches to build back resilient and equitable food systems. First, future interventions need to target structural issues that limit people’s agency in accessing nutritious and diverse food and production capital. Second, local innovation systems and institutions require investment to create a market environment that benefits domestic (small and medium) enterprises and agri‑food supply chain workers without jeopardising the environment. Third, interventions need to be informed by a diverse set of opinions that include the voices of the most marginalised.

scholarly journals Non-Tuberculous Mycobacteria: Molecular and Physiological Bases of Virulence and Adaptation to Ecological Niches

2020 ◽  
Vol 8 (9) ◽  
pp. 1380
Author(s):  
André C. Pereira ◽  
Beatriz Ramos ◽  
Ana C. Reis ◽  
Mónica V. Cunha
Keyword(s):  
Developed Countries ◽  
Decision Makers ◽  
Public Health Issue ◽  
Individual Species ◽  
Ecological Niches ◽  
Research Gaps ◽  
Middle Income ◽  
Middle Income Countries ◽  
Species Specific ◽  
Total Environment

Non-tuberculous mycobacteria (NTM) are paradigmatic colonizers of the total environment, circulating at the interfaces of the atmosphere, lithosphere, hydrosphere, biosphere, and anthroposphere. Their striking adaptive ecology on the interconnection of multiple spheres results from the combination of several biological features related to their exclusive hydrophobic and lipid-rich impermeable cell wall, transcriptional regulation signatures, biofilm phenotype, and symbiosis with protozoa. This unique blend of traits is reviewed in this work, with highlights to the prodigious plasticity and persistence hallmarks of NTM in a wide diversity of environments, from extreme natural milieus to microniches in the human body. Knowledge on the taxonomy, evolution, and functional diversity of NTM is updated, as well as the molecular and physiological bases for environmental adaptation, tolerance to xenobiotics, and infection biology in the human and non-human host. The complex interplay between individual, species-specific and ecological niche traits contributing to NTM resilience across ecosystems are also explored. This work hinges current understandings of NTM, approaching their biology and heterogeneity from several angles and reinforcing the complexity of these microorganisms often associated with a multiplicity of diseases, including pulmonary, soft-tissue, or milliary. In addition to emphasizing the cornerstones of knowledge involving these bacteria, we identify research gaps that need to be addressed, stressing out the need for decision-makers to recognize NTM infection as a public health issue that has to be tackled, especially when considering an increasingly susceptible elderly and immunocompromised population in developed countries, as well as in low- or middle-income countries, where NTM infections are still highly misdiagnosed and neglected.

scholarly journals Metrics to analyze and improve diets through food Systems in low and Middle Income Countries

Food Security ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1085-1105
Author(s):  
Mequanint B. Melesse ◽  
Marrit van den Berg ◽  
Christophe Béné ◽  
Alan de Brauw ◽  
Inge D. Brouwer
Keyword(s):  
Food Systems ◽  
Food System ◽  
Systems Approach ◽  
Analytical Framework ◽  
Data Availability ◽  
Middle Income ◽  
The Sustainable Development ◽  
Middle Income Countries ◽  
Public Data ◽  
Low And Middle Income

Abstract Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food system performance, and evaluate the impacts of food system interventions. Food system metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to identify systematically relevant metrics and indicators based on data availability in low and middle income countries. We conclude that public data are relatively well available for food system drivers and outcomes, but not for all of the food system activities. With only minor additional investments, existing surveys could be extended to cover a large part of the required additional data. For some indicators, however, targeted data collection efforts are needed. As the list of indicators partly overlaps with the indicators for the Sustainable Development Goals (SGDs), part of the collected data could serve not only to describe and monitor food systems, but also to track progress towards attaining the SDGs.

scholarly journals 40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001293 ◽  
Author(s):  
Fanny Chabrol ◽  
Lucien Albert ◽  
Valéry Ridde
Keyword(s):  
Low Income ◽  
Environmental Sustainability ◽  
Public Hospitals ◽  
Decision Makers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Geographical Inequalities ◽  
Urban Rural ◽  
Hospital Construction

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.

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