The illegal wildlife trade threatens the future of many species, and undermines economies and livelihoods. Conservationists have largely responded with supply‐side interventions, such as antipoaching patrols, but these often fail to stem the tide of wildlife trafficking. There is now increasing interest in demand‐side interventions, which seek to lower poaching pressure on sought‐after species by reducing consumer's desire for, and purchase of, specific wildlife products. Individual behavior change approaches, from environmental education to social marketing, have been widely advocated by academics, practitioners, and policy makers. However, this is an emerging field and we lack the breadth of evidence needed to understand and predict the potential outcomes of demand reduction interventions. To help us gain broader insights, we examine the literature from public health and international development on the effectiveness of behavior change interventions, and critique the current conceptualization of strategies for reducing consumer demand in the illegal wildlife trade. We show that behavior change is difficult to achieve and interventions may have unintended and undesirable consequences because of unaddressed systemic, cultural and environmental drivers, and limited resourcing. We conclude that some sections of the conservation community are advocating a shift from one reductionist approach based on limiting supply, to another based on limiting demand, and argue that conservationists should learn from the public health and international development projects that have integrated systems thinking. By accounting for the multiple interactions and synergies between different factors in the wildlife trade, we can develop more strategic approaches to protecting endangered species.
Increasing attention, and a concomitant increase in funds, is being devoted to the strengthening of research capacity for health within low- and middle-income countries. Yet approaches to research capacity strengthening (RCS) are still new, and there is much debate about how to strengthen something that is so difficult to define, let alone measure. This paper aims to inform our understanding of how research capacity is being strengthened, and how we might consider the effectiveness of these initiatives. It does this by examining (a) understandings of and approaches to RCS, and (b) different ways in which RCS is monitored and evaluated. The study included a literature review, internet search, and analysis of the web pages and available documents for six donor organizations key to health RCS. E-mail and telephone discussions were conducted with experts in the area of health RCS, as well as semi-structured telephone interviews with representatives from the six identified organizations. The study found that understandings of and approaches to RCS are wide ranging. We are at the early stages of knowing how best to identify, target and affect the many factors that are important for stronger research capacity. Furthermore, as RCS initiatives become more wide-ranging and complex, they become more difficult to monitor and evaluate. Donors are struggling with many challenges associated with tracking RCS initiatives. There is no consensus on the best methods or tools to use. There is a clear need for improved strategies and the development of a tried and tested framework for RCS tracking.
Introduction In Europe, integrated care sites are increasingly being put in place to provide care to older people with multiple health and social care needs who live at home [1, 2]. In this context, integrated care is defined as those approaches that proactively seek to structure and coordinate health and social care for older people in their home environments, centred around older people's needs [3-7]. One of the main principles of integrated care is person-centredness [8-12]. The literature includes several definitions of person-centredness but a universally agreed one is lacking [13-18]. Common elements in these definitions include: 1) empowering and encouraging people to participate actively, as equal partners, in decision-making processes about their own care, and/or to manage their own health and care; 2) establishing an accommodating, cooperative and ongoing relationship between the professional, the person receiving care and the informal carer, including respectful communication and active listening; 3) having an understanding of the specific (health) concerns of
BackgroundThe wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning.MethodsWe conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas.ResultsPublic health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint.ConclusionsOur findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system.
Background: The 2013-2016 Ebola virus disease (EVD) epidemic in West Africa was the largest in history and resulted in a huge public health burden and significant social and economic impact in those countries most affected. Its size, duration and geographical spread presents important opportunities for research than might help national and global health and social care systems to better prepare for and respond to future outbreaks. This paper examines research needs and research priorities from the perspective of those who directly experienced the EVD epidemic in Guinea. Methods: The paper reports the findings from a research scoping exercise conducted in Guinea in 2017. This exercise explored the need for health and social care research, and identified research gaps, from the perspectives of different groups. Interviews were carried out with key stakeholders such as representatives of the Ministry of Health, non-governmental organizations (NGOs), academic and health service researchers and members of research ethics committees (N=15); health practitioners (N=12) and community representatives (N=11). Discussion groups were conducted with male and female EVD survivors (N=24) from two distinct communities. Results: This research scoping exercise identified seven key questions for further research. An important research priority that emerged during this study was the need to carry out a comprehensive analysis of the wider social, economic and political impact of the epidemic on the country, communities and survivors. The social and cultural dynamics of the epidemic and the local, national and international response to it need to be better understood. Many survivors and their relatives continue to experience stigma and social isolation and have a number of complex unmet needs. It is important to understand what sort of support they need, and how that might best be provided. A better understanding of the virus and the long-term health and social implications for survivors and non-infected survivors is also needed. Conclusion: This study identified a need and priority for interdisciplinary research focusing on the long-term sociocultural, economic and health impact of the EVD epidemic. Experiences of survivors and other non-infected members of the community still need to be explored but in this broader context.
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