Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research

Background Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including vulnerable and marginalised groups. When done right, it can also support empowerment of wider communities in taking ownership of their own health, lead to increased access and uptake of health services and generally improve the wellbeing of individuals. However, the evidence base of how to undertake successful community engagement and involvement (CEI) activities in LMICs is sparse. This paper aims to add to the available literature and describes how the Global Health Research Unit on Global Surgery’s (GSU) team in Ghana worked collaboratively with the Unit’s team in the UK and a UK-based Public Advisory Group to involve community stakeholders in rural Ghana with surgical research. The aim was to explore ways of reaching out to patients and community leaders in rural Ghana to have conversations that inform the relevance, acceptability, and feasibility of a clinical trial, called TIGER. Methods As this kind of larger scale involvement of community stakeholders with research was a novel way of working for the team in Ghana, a reflective approach was taken to outline step-by-step how the GSU team planned and undertook these involvement activities with 31 hernia patients, two Chiefs (community leaders), a community finance officer and a local politician in various locations in Ghana. The barriers that were experienced and the benefits of involving community stakeholders are highlighted with the aim to add to the evidence base of CEI in LMICs. Results GSU members from the UK and Ghana planned and organised successful involvement activities that focused on establishing the best way to talk to patients and other community stakeholders about their experiences of living with hernias and undergoing hernia repairs, and their perceptions of the impact of hernias on the wider community. The Ghanaian team suggested 1:1 conversations in easily accessible locations for rural patient contributors, creating a welcoming environment and addressing contributors in their local dialects. A UK-based Public Advisory Group helped in the initial stages of planning these conversations by highlighting potential barriers when approaching rural communities and advising on how to phrase questions around personal experiences. Conversations mainly focused on understanding the needs of hernia patients in rural Ghana to then incorporate these in the design of the TIGER trial to ensure its relevance, acceptability and feasibility. When talking to patient contributors, the GSU teams found that they were more likely to open up when they knew members of the team and the opportunity to speak to local leaders only arose because of the Ghanaian team members being well-respected amongst communities. The experiences of the patient and community contributors led to changes in the study protocol, such as including women in the patient cohort for the trial, and allowed the GSU teams to confirm the relevance and acceptability of this trial. These conversations also taught the team a lot about perceptions of health in rural communities, allowed the Ghanaian team to establish relationships with community leaders that can be utilised when future studies need input from the public, and has changed the minds of the Ghanaian research team about the importance of involving patients with research. Conclusion This paper contributes to the evidence base on successful CEI activities in LMICs by providing an example of how CEI can be planned and organised, and the benefits this provides. The conversations the teams had with patient contributors in Ghana are an example of successful patient consultations. Even though there are certain limitations to the extent of these involvement activities, a solid foundation has been built for researchers and community stakeholders to establish relationships for ongoing involvement.

INFORMATION OPENNESS OF PUBLIC ADVISORY COUNCILS IN ST. PETERSBURG: COMPARATIVE ANALYSIS OF CONDITIONS

Information openness of public advisory councils is an important but underexplored indicator of their role in public policy. It reflects their activities, as well as the feedback mechanisms between citizens and councils. Scholars point out low information quality on federal and regional levels, but the reasons behind that rarely studied, especially from a comparative perspective. This paper attempts to fill in this gap by revealing the conditions leading to greater information openness. The authors choose St. Petersburg as a case and gather a dataset on 46 public councils. The key research method is the fuzzy-set qualitative comparative analysis. The framework is built on two expectations: the impact of councils’ autonomy (in website management and general organization) and the role of councils (“intermediary” or “expert”) on information openness.Due to several limitations, the results have not revealed any conditions which can be considered a guarantee for better openness. However, the preliminary conclusion is that the differences in autonomy and roles are important conditions. The autonomy of councils seems to be the most crucial factor. A valuable contribution of this paper is the framework of analysis that can be used for other cases and research strategies.

MAIN APPROACHES TO INTERACTION BETWEEN THE STATE AND CIVIL SOCIETY IN THE RUSSIAN FEDERATION

The article considers the issue of interaction between the state and civil society, analyzes the main approaches and models of such interaction. The author notes the important consolidating role played by public and public Advisory Councils under state authorities in Russian society.

Small‑Scale Apple Farmers’ Willingness to Invest – The Case of Korça Region Farmers in Albania

In this study we aim at assessing the willingness to invest of small‑apple farms in Korça region‑Albania. Furthermore, we want to identify and assess what are major determinants, as percept by farmers’, willingness to invest. To this purpose we used data collected through face‑to‑face interviews with apple farmers. We used descriptive statistics, as well as classical and multinomial logistic regression. Most of farmers are willing to invest in view of their positive expectations for investment climate. Other important factors of willingness to invest are access to loans, advisory extension services, market competition, willingness to cooperate and willingness to take loans, and farm income, while socio‑demographic factors such as age, education, and farming experience do not have significant effect on willingness to invest. Large farms are generally more willing to invest. We present also a general framework of constraints and policy levers to improving the investment climate which is almost valid also for Albania. Improving farmers’ access to private credit sources, policy stability, providing information and public advisory services to small farmers, support farmers to adopt new technology, support to the creation of farmers’ formal and informal groups, and mitigate risks of various type are some but essential policy measures to motivate farmers to invest more in apple.

AGRICULTURAL ADVISORY – TRANSFORMATION EXPERIENCES AND NEW CHALLENGES

The aim of this article is to identify the challenges facing public advisory services, resulting from the expectations of farmers and rural inhabitants and to present the most important steps which should be taken to address these challenges. The main problem faced by Polish farmers is primarily the improvement of competitiveness that can be achieved by increasing (economical, environmental and social) efficiency. Agricultural advisory centers must work closely with science and agricultural education to effectively support farmers. In view of the new challenges facing advisory services, there is a need for an integrated agricultural information system. The development of such a system is necessary for the advisors to move from providing information and supporting farmers in raising EU funds to actions aimed at improving production efficiency.

Policy analysis in advisory councils

This chapter explores the increasing and rather prominent role of public advisory boards in the Mexican federal government with emphasis on policy analysis instruments and methods, conditions for sound analysis, and existing organizational capabilities. The chapter is organized into four sections. The first provides a definition of the term “advisory boards”, given its different and at times contradictory uses. The second section describes the construction and criteria used to build the first universe of advisory boards in the Mexican federal government, circa 2015. The third part presents a comparative analysis of two of the most influential advisory boards in Mexico: CONEVAL, devoted to the evaluation of social policy, and INECC, in charge of providing technical and scientific advice to environmental decision makers. The fourth section discusses the main findings and presents conclusions.

Role of Private Advisory Services in Agricultural Extension: A Review

Services that make new knowledge available to farmers and assist the farmers to develop their farming and management skills are known as agricultural advisory services. Agricultural extension and advisory services which were traditionally funded, managed and delivered by the public sector are in transitory phase worldwide. They are under increased pressure to reform their purpose as the nature of the agricultural and rural sectors is changing leading to demand for broader support from extension and advisory services. Technology transfer system has to become more demand driven and responsive to farmers need and helping farmers to organize themselves as well as linking them to markets. The advisory services has to also support other pertinent areas besides production such as value addition, market access, trade, agribusiness management, natural resource management, gender, climate change etc. It is in this light that the private advisory services are complementing, supplementing or even replacing the public advisory services.Emergence of paid extension services in agriculture is a recent development, where, professionals have been providing paid consultancy to farmers on technical, especially in high value crops like fruits and flowers.These agri-consultant are mostly retired professors of State Agricultural Universities (SAUs), extension professionals, financial institutions and also provided by Agri-Clinics and Agri-Business Centers (ACABCs) trained by the MANAGE.