Provider perspectives and reach of an evidence-based intervention in community services for toddlers

Best-practice recommendations for young children at high likelihood of autism include active involvement of caregivers in intervention. However, the use of evidence-based parent-mediated interventions in community practice remains limited. Preliminary evidence suggests that Project ImPACT for Toddlers demonstrates positive parent and child outcomes in community settings. Project ImPACT for Toddlers was adapted specifically for toddlers and teaches parents of young children strategies to build their child’s social, communication, and play skills in daily routines. This study reports implementation outcomes from the initial community rollout of Project ImPACT for Toddlers and examines the system-wide intervention reach, with the goal of informing continued community sustainment and scale-up. Participants include 38 community providers who participated in a Project ImPACT for Toddlers’ training study who completed an implementation survey and semi-structured interviews after approximately 3 months of community implementation. Participants perceived the training model as acceptable and appropriate, and identified several strengths of the approach. Interview themes also supported the feasibility, acceptability, and utility of the intervention in community settings. Quantitative findings complemented the thematic results from interviews. Intervention reach data indicate an increasing number of agencies delivering and families receiving Project ImPACT for Toddlers. Efforts to scale-up evidence-based interventions in early intervention should continue to build upon the model of the Bond, Regulate, Interact, Develop, Guide, and Engage Collaborative. Lay abstract Expert recommendations for toddlers who are likely to develop autism include caregivers being actively involved in the services children receive. However, many services available in the community may not follow these recommendations. Evidence suggests that an intervention named Project ImPACT for Toddlers demonstrates positive parent and child outcomes for families in the community. Project ImPACT for Toddlers was designed specifically for toddlers by a group of parents, clinicians, researchers, and funders. It teaches parents of young children strategies to support their child’s development in daily routines. This study reports the perspectives of early intervention providers who learned to use Project ImPACT for Toddlers on whether the intervention was a good fit for their practice and easy to use. The study also examines how many agencies are using Project ImPACT for Toddlers and how many families have received the intervention in the community. The goal of the study is to inform the continued use of Project ImPACT for Toddlers in the community and support offering the intervention in other regions. Participants include 38 community providers who participated in a training study of Project ImPACT for Toddlers and completed a survey and semi-structured interview after approximately 3 months of using Project ImPACT for Toddlers with families. Participants perceived the training model as acceptable and appropriate, and identified the group-based model of training, comprehensive materials, and agency support as strengths of the approach. Survey findings complemented the results from the interviews. Data indicate an increasing number of agencies and families accessing Project ImPACT for Toddlers. Efforts to expand evidence-based intervention in early intervention should continue to build upon the model used for Project ImPACT for Toddlers.

What Makes Community Health Worker Models for Tuberculosis Active Case Finding Work? A Cross-Sectional Study of TB REACH Projects to Identify Success Factors for Increasing Case Notifications

Background In the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-sale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks. Methods We conducted a cross-sectional study analyzing the TB REACH data repository (n=123) and primary survey responses (n=50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications. Results Most projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives. Conclusion In line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Industrial Zone Development by Warehouse and Production Hall Constructions

The article focuses on the analysis of the development and use of industrial zones, which represent areas for the concentrated location of manufacturing sites specialised in a particular industry, strategic services, or technology centres. Both services and industry have an impact as the top engines of Gross Domestic Product and the labour force employment both in the Czech Republic and European Union. The area and the predominant category of economic activities are important parameters of each industrial zone. They place demands on the employees, transport, technical equipment, landscape, and settlement within the impact on the territory. The main goal of the research was the analysis of the industrial zone as a territory where warehouse and production hall projects are implemented. The analysis of warehouse and production hall construction investment was performed in Žďár nad Sázavou. The study of this project presents the project impact on the industrial area and the deviation between the project plan and the audited reality. The research sample consisted of 12 selected warehouse and production hall projects located in Central and Eastern Europe in various phases of their life cycle - the planning, implementation or operational phases. One of the partial outputs of the article is a SWOT analysis which deals with variables that affect project effectiveness both from the perspective of the investor and the public in the area where they are located. Implementation and operation of such projects significantly affect public life, so their potential socio-economic impact on the economic cash flow creation was examined.

Effectiveness of I’m Learning for achieving quality learning environments

From 2013 to 2017, Save the Children Norway tested the hypothesis that a global framework could be used to empower locally driven solutions within the education sector. It did so by galvanizing support and aligning stakeholders to common goals articulated through the Quality Learning Environment Framework but allowing each community context to determine its own path for achieving those goals. This article explores the effectiveness and impact of these projects across the three pilot countries of Cambodia, Uganda, and Zimbabwe as defined by the original project goals, outcomes, and objectives. Reflecting on both qualitative and quantitative data gathered throughout the life of the project, the article speaks to project impact and achievements as well as operational findings including commonalities and differences between the three pilot projects and keys to success. It outlines lessons learned across the programming sites and in doing so it explores the role of a large International Non-Governmental Organization as a catalyst for change. Finally, it discusses the rigorous research and reporting framework driven by funders and development agencies, the rigidity of which struggled to capture the emergent nature of locally driven solutions.

What Makes Community Health Worker Models for Tuberculosis Active Case Finding Work? A Cross-sectional Study of TB REACH Projects to Identify Success Factors for Increasing Case Notifications

Background: In the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-sale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks.Methods: We conducted a cross-sectional study analyzing the TB REACH data repository (n=123) and primary survey responses (n=50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications. Results: Most projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives.Conclusion: In line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Potential Private Sector Involvement in Supporting Refugee Livelihoods and Self-reliance in Uganda: Annotated Bibliography

There is some evidence of the private sector playing a role in supporting refugee livelihoods and self-reliance in Uganda during the period 2016-2020. However, a number of evaluations and research reports highlight the potential for greater private sector involvement, if existing constraints are addressed. Key lessons identified in the literature include the need for more research, especially on market potential, to address the existing knowledge gaps on the role the private sector can play in supporting refugee livelihoods and self-reliance in Uganda. The literature notes that limited access to capital, as well as appropriate financing schemes, are key constraints to the growth of the agribusiness sector. Furthermore, access to natural resources required for agri-business, such as land and water needs to receive more attention from NGOs and donors. The evidence also shows that there is a need for guidelines on the monitoring and evaluation of humanitarian adaptations of market systems development programming. The literature also notes that local actors should be involved in the design and assessment of investment opportunities and risk of interventions to increase project impact.

Impact of Climate Change on Agricultural Development in a Closed Groundwater-Driven Basin: A Case Study of the Siwa Region, Western Desert of Egypt

The Siwa region located in the Western Desert of Egypt has 30,000 acres available for reclamation as a part of a national project to increase agricultural production. This study addressed the climate change-driven long-term concerns of developing an agricultural project in this region where groundwater from the non-renewable Nubian Sandstone Aquifer System (NSAS) is the only source of water. Different climate models were used under two representative concentration pathways (RCPs); RCP 4.5 and RCP 8.5. Projected seasonal temperatures show that the maximum increase in summer is 1.68 ± 1.64 °C in 2060 and 4.65 ± 1.82 °C in 2100 under RCP 4.5 and RCP 8.5, respectively. The increase in water requirement for crops is estimated around 6–8.1% under RCP 4.5 while around 9.7–18.2% under RCP 8.5. Maximum reductions of strategic crop yields vary from 2.9% to 12.8% in 2060 under RCP 4.5, while from 10.4% to 27.4% in 2100 under RCP 8.5. Project goals are feasible until 2100 under RCP 4.5 but only until 2080 with RCP 8.5. When an optimization analysis was conducted, these goals are possible from 2080 to 2100 by modified land allocation. The proposed methodology is useful to project impact of climate change anywhere such that management and adaptation options can be proposed for sustainable agricultural development.