Introduction

This book provides policy framework on “towards a Green Economy in the Transport Sector” draws inspiration from the UNEP report on Green Economy Modeling (2014), which focused on South Africa with respect to Transport, Natural Resource Management, Agriculture, and Energy sectors. This is because in the last 10 years natural resources, environmental risks and ecological issues have come to the attention of the international community because the subject is fundamentally important for overarching sustainable growth. It is important to note that environmental problems such as greenhouse gas emissions and climate change in different regions of the world including South Africa result in significant problems. However, the challenges can provide an opportunity to do things differently. Further to this in 2010, South Africa hosted the Green Economy Summit to set up the stage for the formulation of a Green Economy Plan. In line with this, the choice for a New Growth Path (NGP) was formulated and it was aimed at creating new green jobs in their thousands by 2020. It was in this context that the NGP policy framework on green economy in the transport sector was envisaged to respond to the request by Transport Education and Training Authority (TETA) to assess potential opportunities and policy levers to inform a green economy in the transport sector. The findings from the desktop research, the stakeholder workshop and the field survey reports form the basis from which the policy framework recommendations in this report were made.

Participatory Mapping of Demand for Ecosystem Services in Agricultural Landscapes

Agricultural land use systems have been optimized for producing provisioning ecosystem services (ES) in the past few decades, often at the expense of regulating and cultural services. Research has focused mainly on the supply side of ES and related trade-offs, but the demand side for regulatory services remains largely neglected. The objective of this paper is to evaluate the usefulness of participatory geographic information system (PGIS) methods for demand assessment in larger rural and agrarian contexts by identifying spatially explicit demand patterns for ES, thereby enlarging the body of participatory approaches to ES-based land use management. Accordingly, we map, assess, and statistically and spatially analyze different demands for five ES by different stakeholder groups in agricultural landscapes in three case studies. The results are presented in a stakeholder workshop and prerequisites for collaborative ES management are discussed. Our results show that poor correlation exists between stakeholder groups and demands for ES; however, arable land constitutes the highest share of the mapped area of demands for the five ES. These results have been validated by both the survey and the stakeholder workshop. Our study concludes that PGIS represents a useful tool to link demand assessments and landscape management systematically, especially for decision support systems.

Design considerations for overdose education and Naloxone distribution: Results of a multi-stakeholder workshop

Background Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to design an open-access naloxone kit and ultra-brief education session for use in point-of-care settings. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for the kit and education session. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a one-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling which revealed seven design considerations: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. Conclusion To create an open access kit and ultra-brief education session for distribution in emergency departments, family practice and substance use treatment services, stigma is a central design consideration. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.

An assessment of the capacity and responsiveness of a national system to address the threat of invasive species: a systems approach

Background Invasive species affect the social, economic and health aspects of many farmers and are known to cause major losses with considerable costs spent on management. Several international agreements recognise the threat caused by invasive species which signatories have an obligation to manage. This paper sets out a framework and method for assessing the performance and responsiveness of a country’s invasive species system. The objective is to engage with key actors within an invasive species system using a participatory approach to determine the strengths, weaknesses and functioning of the invasive species system. The aim is to understand the system as it currently stands and to identify opportunities and challenges from various actor’s perspectives. Method The first step was to define an invasive species system and its component parts including the functions, expected outputs and contextual factors. A range of indicators and participatory tools were developed to measure system performance. The process includes a desk review, stakeholder workshop and key informant interviews. The approach was piloted in Kenya. Results Actors who are active in managing invasive species were identified and engaged. The assessment process provided insights into the current functioning of the invasive species system. A number of key challenges were identified, for instance, the lack of finance, governance and leadership, as major barriers to effective system performance, alongside the lack of a central coordinating body to guide invasive species management. Conclusion The systems approach developed helped in facilitating the engagement of key actors within a country’s invasive species system. The actors performed a self-assessment of the current system status and determined what is required to move towards more effective management of invasive species. Participants responded positively to the framework and process developed, which contributed to developing ownership and clear steps forward towards a more pro-active, rather than reactive, approach in the management of invasive species.

Core Outcome Measures for Palliative and End-of-Life Research After Severe Stroke: Mixed-Method Delphi Study

Background and Purpose: Stroke is the second commonest cause of death worldwide and a leading cause of severe disability, yet there are no published trials of palliative care in stroke. To design and evaluate palliative care interventions for people with stroke, researchers need to know what measurable outcomes matter most to patients and families, stroke professionals, and other service providers. Methods: A multidisciplinary steering group of professionals and laypeople managed the study. We synthesized recommendations from respected United Kingdom and international consensus documents to generate a list of outcome domains and then performed a rapid scoping literature review to identify potential outcome measures for use in future trials of palliative care after stroke. We then completed a 3-round, online Delphi survey of professionals, and service users to build consensus about outcome domains and outcome measures. Finally, we held a stakeholder workshop to review and finalize this consensus. Results: We generated a list of 36 different outcome domains from 4 key policy documents. The rapid scoping review identified 43 potential outcome measures that were used to create a shortlist of 16 measures. The 36 outcome domains and 16 measures were presented to a Delphi panel of diverse healthcare professionals and lay service users. Of 48 panelists invited to take part, 28 completed all 3 rounds. Shared decision-making and quality of life were selected as the most important outcome domains for future trials of palliative care in stroke. Additional comments highlighted the need for outcomes to be feasible, measurable, and relevant beyond the initial, acute phase of stroke. The stakeholder workshop endorsed these results. Conclusions: Future trials of palliative care after stroke should include pragmatic outcome measures, applicable to the evolving patient and family experiences after stroke and be inclusive of shared decision-making and quality of life.

Reporting standards, outcomes and costs of quality improvement studies in Ireland: a scoping review

ObjectivesTo profile the aims and characteristics of quality improvement (QI) initiatives conducted in Ireland, to review the quality of their reporting and to assess outcomes and costs.DesignScoping review.Data sourcesSystematic searches were conducted in PubMed, Web of Science, Embase, Google Scholar, Lenus and rian.ie. Two researchers independently screened abstracts (n=379) and separately reviewed 43 studies identified for inclusion using a 70-item critique tool. The tool was based on the Quality Improvement Minimum Quality Criteria Set (QI-MQCS), an appraisal instrument for QI intervention publications, and health economics reporting criteria. After reaching consensus, the final dataset was analysed using descriptive statistics. To support interpretations, findings were presented at a national stakeholder workshop.Eligibility criteriaQI studies implemented and evaluated in Ireland and published between January 2015 and April 2020.ResultsThe 43 studies represented various QI interventions. Most studies were peer-reviewed publications (n=37), conducted in hospitals (n=38). Studies mainly aimed to improve the ‘effectiveness’ (65%), ‘efficiency’ (53%), ‘timeliness’ (47%) and ‘safety’ (44%) of care. Fewer aimed to improve ‘patient-centredness’ (30%), ‘value for money’ (23%) or ‘staff well-being’ (9%). No study aimed to increase ‘equity’. Seventy per cent of studies described 14 of 16 QI-MQCS dimensions. Least often studies reported the ‘penetration/reach’ of an initiative and only 35% reported health outcomes. While 53% of studies expressed awareness of costs, only eight provided at least one quantifiable figure for costs or savings. No studies assessed the cost-effectiveness of the QI.ConclusionIrish QI studies included in our review demonstrate varied aims and high reporting standards. Strategies are needed to support greater stimulation and dissemination of QI beyond the hospital sector and awareness of equity issues as QI work. Systematic measurement and reporting of costs and outcomes can be facilitated by integrating principles of health economics in QI education and guidelines.

Complex Socio-Ecological Systems: Translating Narratives into Future Land Use and Land Cover Scenarios in the Kilombero Catchment, Tanzania

The Kilombero wetland in Tanzania is affected by advancing land use and land cover changes (LULCC), where we observe a conflict between development interests and the necessity of conservation measures to maintain the functionalities of the ecosystem. Thus, assessing patterns of LULCC is crucial to foresee potential future developments and to develop sustainable future management strategies. In this study, we use a multi-method scenario approach to assess the spatial implications and underlying driving forces of potential change by (1) developing a System Dynamics Causal Loop Diagram (CLD) to disentangle the underlying socio-economic and ecologic driving forces, (2) deriving a qualitative business-as-usual (BAU) and a conservation scenario from participatory narratives elaborated during a stakeholder workshop, and (3) quantifying the spatial implications of these scenarios with the Land Change Modeler (LCM). Results indicate that under the BAU assumption only 37% of the natural vegetation is expected to persist until 2030 in the wetland. In contrast, strict enforcement of protected areas (conservation scenario) halts further conversion of the wetland. However, both scenarios pinpoint considerable expansions of cropland in the western highlands with potentially serious impacts on catchment-wide hydrological processes. The produced qualitative and quantitative outputs reveal hotspots of possible future change and starting points for advisable further research and management interventions.