Scale-up of prevention programmes: sustained state-wide use of programme delivery software is explained by normalised self-organised adoption and non-adoption

Background Population-level health promotion is often conceived as a tension between “top-down” and “bottom-up” strategy and action. We report behind-the-scenes insights from Australia’s largest ever investment in the “top-down” approach, the $45m state-wide scale-up of two childhood obesity programmes. We used Normalisation Process Theory (NPT) as a template to interpret the organisational embedding of the purpose-built software designed to facilitate the initiative. The use of the technology was mandatory for evaluation, i.e. for reporting the proportion of schools and childcare centres which complied with recommended health practices (the implementation targets). Additionally, the software was recommended as a device to guide the implementation process. We set out to study its use in practice. Methods Short-term, high-intensity ethnography with all 14 programme delivery teams across New South Wales was conducted, cross-sectionally, 4 years after scale-up began. The four key mechanisms of NPT (coherence/sensemaking, cognitive participation/engagement, collective action and reflexive monitoring) were used to describe the ways the technology had normalised (embedded). Results Some teams and practitioners embraced how the software offered a way of working systematically with sites to encourage uptake of recommended practices, while others rejected it as a form of “mechanisation”. Conscious choices had to be made at an individual and team level about the practice style offered by the technology—thus prompting personal sensemaking, re-organisation of work, awareness of choices by others and reflexivity about professional values. Local organisational arrangements allowed technology users to enter data and assist the work of non-users—collective action that legitimised opposite behaviours. Thus, the technology and the programme delivery style it represented were normalised by pathways of adoption and non-adoption. Normalised use and non-use were accepted and different choices made by local programme managers were respected. State-wide, implementation targets are being reported as met. Conclusion We observed a form of self-organisation where individual practitioners and teams are finding their own place in a new system, consistent with complexity-based understandings of fostering scale-up in health care. Self-organisation could be facilitated with further cross-team interaction to continuously renew and revise sensemaking processes and support diverse adoption choices across different contexts.

Systems Integration in Infrastructure Projects: Seven Lessons from Crossrail

We propose a systems integration model for the delivery of complex infrastructure projects. We argue that the client is ultimately accountable for systems integration in major projects, setting out the responsibilities to ensure that systems integration is successfully accomplished to achieve desired outcomes. From the Crossrail case, we draw seven lessons for clients, to: 1) manage programme delivery as an integration activity; 2) actively manage systems integration; 3) ensure authority to make decisions; 4) maintain configuration control; 5) plan for a lengthy testing and commissioning phase; 6) appreciate supply chain products may be part of unaligned global R&D and development programmes; and 7) do final integration only when there is something to integrate. Central to our argument is the idea that on such complex projects, the client cannot outsource systems integration and thus needs to recognize they retain accountability, though roles and responsibilities can be assigned to the delivery partner, supply chain, chief engineer and/or contracted systems integration firm. A key question for the client at the outset is how to distribute interface management and systems integration responsibilities while retaining accountability and oversight. Rather than managing through contracts, budgets and schedules, we suggest a changed approach with priority given to managing integration, and contracts, budgets and schedules that support and incentivise this.

Re-thinking Contextualisation in Solomon Islands school leadership professional learning and development

This article discusses the perceptions of Solomon Island mentors and regional administrators of a Solomon Islands aid-funded school leadership professional learning and development intervention. The focus is on contextualisation, used here as a broad term to refer to the adoption of ways of understanding, thinking and working recognisable and coherent within local practice. The scope of the article includes the significance of the configuration of relationships between delivery partners, the power of cause-based motivation, programme delivery protocols and ways of understanding successful outcomes. Using data drawn from two perspectives in a multi-facetted programme construction and delivery model, the article offers some provocations regarding the potential of re-framing relationships and practices in aid-funded development programmes in educational leadership and beyond.

EDITORIAL: Impact of COVID-19 pandemic on higher education in Japan: Transition to online education and challenges in experiential pharmacy practice

The COVID-19 pandemic has impacted all aspects of human life, including pharmacy education worldwide. This article depicts how the COVID-19 pandemic has impacted higher education in Japan with a focus on two topics: the transition to online education and the challenges faced in experiential pharmacy practice. In both topics, the sharing of information among educators and stakeholders, from students to governmental ministries, played vital roles in keeping the programme delivery as normal as possible during the pandemic. Insights gained from experience during the pandemic should offer a basis for the robust and versatile framework of tomorrow’s pharmacy education.

Mass administration of medicines in changing contexts: Acceptability, adaptability and community directed approaches in Kaduna and Ogun States, Nigeria

Nigeria has the highest burden of NTDs in sub-Saharan Africa. Commitments to reach the control and elimination of many Neglected Tropical Diseases (NTDs), particularly those amenable to preventive chemotherapy (onchocerciasis, schistosomiasis, soil transmitted helminths, lymphatic filariasis and trachoma) by 2020 are detailed in the London declaration. Strategies to reach targets build on existing approaches, one of which is the use of community directed intervention (CDI) methods to deliver the mass administration of medicines (MAM). However, treatment using this approach has been inconsistent and there are questions about the acceptability and adaptability of these interventions during periods of programmatic, social, and political change. This paper explores the current strengths and weaknesses of CDI approaches in MAM delivery. We consider the acceptability and adaptability of existing MAM approaches to ensure equity in access to essential treatments. Using qualitative methods, we explore implementer perspectives of MAM delivery. We purposively selected programme implementers to ensure good programmatic knowledge and representation from the different levels of health governance in Nigeria. Data collection took place across two States (Kaduna and Ogun). Our results indicate that CDI approaches have underpinned many historic successes in NTD programme acceptance in Nigeria, specifically in Kaduna and Ogun State. However, our results also show that in some contexts, factors that underpin the success of CDI have become disrupted presenting new challenges for programme implementers. Capturing the tacit knowledge of health implementers at varying levels of the health system, we present the current and changing context of MAM delivery in Kaduna and Ogun States and consolidate a platform of evidence to guide future programme delivery and research studies. We situate our findings within the broader NTD literature, specifically, in identifying how our findings align to existing reviews focused on factors that shape individual acceptance of MAM.

Donor reliance and the impact on neglected tropical disease programme delivery: reflections and solutions for change from programme management perspectives

Health systems within many developing countries are reliant on donor funding and non-governmental development organisations (NGDOs); this has had positive results but also presents challenges to sustainability and national ownership, with national programmes needing to respond to changing donor priorities. Simultaneously, the WHO neglected tropical disease (NTD) roadmap 2021–2030 calls for increased country ownership and domestically financed NTD programmes. Focusing on Liberia and blending primary research from the COUNTDOWN consortium and personal programmatic experience, this commentary reflects on the sustainability and financing of NTD programme delivery within the current context. We explore the successes and challenges of current models of collaboration and opportunities to improve country ownership and sustainability.

Relationships in the Implementation of Conditional Cash Transfers: The Provision of Health in the Oportunidades-Prospera Programme in Puebla, Mexico

This article explores interactions between the front-line officers and recipients of Oportunidades-Prospera, a conditional cash transfer (CCT) in Mexico. Like other CCTs, Oportunidades-Prospera provided monetary transfers to families with the requirement of following certain conditions, including receiving preventive healthcare and workshops. This produced constant and compulsory physician-recipient interactions. This article examines these through observations of programme delivery and interviews with physicians at health centres of two localities of Puebla. The results show that officers’ strategies of implementation and attitudes towards recipients were influenced by the programme’s use of health services as conditionalities, promoting a relationship of authority and obedience. This, however, was exacerbated by the officer’s job position. Those with a permanent contract systematically fostered authoritarian interactions compared to officers with temporary contracts. Ultimately, this study reveals factors that influence officer-recipient relationships in CCTs and their centrality for programme delivery and for the success of social policies more broadly.

Re-thinking Contextualisation Attribution in Solomon Islands school leadership

This article discusses the perceptions of Solomon Island mentors and regional administrators of a Solomon Islands aid-funded school leadership professional learning and development intervention. The focus is on contextualisation, used here as a broad term to refer to the adoption of ways of understanding, thinking and working recognisable and coherent within local practice. The scope of the article includes the significance of the configuration of relationships between delivery partners, the power of cause-based motivation, programme delivery protocols and ways of understanding successful outcomes. Using data drawn from two perspectives in a multi-facetted programme construction and delivery model, the article offers some provocations regarding the potential of re-framing relationships and practices in aid-funded development programmes in educational leadership and beyond.

Re-thinking Contextualisation Attribution in Solomon Islands school leadership

This article discusses the perceptions of Solomon Island mentors and regional administrators of a Solomon Islands aid-funded school leadership professional learning and development intervention. The focus is on contextualisation, used here as a broad term to refer to the adoption of ways of understanding, thinking and working recognisable and coherent within local practice. The scope of the article includes the significance of the configuration of relationships between delivery partners, the power of cause-based motivation, programme delivery protocols and ways of understanding successful outcomes. Using data drawn from two perspectives in a multi-facetted programme construction and delivery model, the article offers some provocations regarding the potential of re-framing relationships and practices in aid-funded development programmes in educational leadership and beyond.