A Holistic Approach Including Biological and Geological Criteria for Integrative Management in Protected Areas.

Biodiversity hotspots and geosites are indivisible parts of natural heritage. Therefore, an adequate spatial delimitation and understanding of both and their linkages are necessary in order to be able to establish conservation policies. Normally, biodiversity hotspots are a typical target for those policies but, generally, geosites are not taken into account. Thus, this paper aims to fill this gap by providing an easily replicable method for the identification and integration of the geosites and the biodiversity hotspots in a Network for Integrative Nature Conservation that highlights their linkages. The method here presented has been applied to Urdaibai Biosphere Reserve situated in southeastern of the Bay of Biscay. The obtained results indicate that some geosites that are not directly related with biodiversity hotspots remain unprotected. Thus, from the study carried out, it can be stated that we conserving just the biodiversity hotspots is not enough to conserve the whole natural heritage of a protected area, as some plots interesting due to their relevant geoheritage remain unprotected. Therefore, it is necessary to fully integrate geosites into the planning documents of protected areas as a part of an ecosystem approach. The ecosystem approach recognizes the integrity of abiotic and biotic elements in nature conservation policies. Moreover, the proposed framework and the innovative methodology can be used as an easy input to identify priority areas for conservation, to improve the protected areas conservation planning, and to demonstrate the linkages between biodiversity hotspots and geosites.

How innovative and conventional curricula prepare medical students for practice in Sub-Saharan Africa: A comparative study from Mozambique.

BACKGROUND: Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. METHODS: We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. RESULTS: Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. DISCUSSION: In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation.

Students' and junior doctors' preparedness for the reality of practice in sub-Saharan Africa.

BACKGROUND: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. AIM: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. METHODS: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. RESULTS: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. CONCLUSION: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region.

Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries.

INTRODUCTION: The Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up. METHODS AND ANALYSIS: Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews. ETHICS AND DISSEMINATION: This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project's course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals.

Economic Costs of Violence Against Women in Mozambique.

Huge efforts have been made to make society aware of the concerns of violence against women (VAW). Hiding this phenomenon creates obstacles to quantify and clearly understand related aspects as well as leads to barriers to undertake actions for the reduction or elimination of VAW. The aim of this study is to estimate costs associated with VAW and produce data that will help in the design of strategies for the reduction or elimination of VAW. The economic cost of VAW was calculated for the cities of Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005-2008). Calculation of economic costs of VAW considered costs for health care, judicial costs, the assistance provided by the justice services, and support from civil society organizations offering services to women subjected to violence. The economic cost of VAW in Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005-2008), was US$1,473,828.7, with the health sector absorbing about 81% of the amount, justice 17%, and organizations working in the area of prevention with 2%. Although calculated costs represent an estimate, it is clear that VAW consumes a significant amount of the state budget. Estimated value is much higher than the budget allocated to the National Action Plan for Prevention and Combat of Violence Against Women. The improvement of collection of statistical data may lead to producing more robust estimates and have more absolute and comparable data.

Progress testing in resource-poor countries: a case from Mozambique.

A wealth of evidence for the effectiveness of progress testing in problem-based learning curricula has been collected in the Western academic world, but whether the progress testing can be equally effective in problem-based medical schools in resource-poor countries is a question that remains to be answered. In order to provide an initial answer to this question, we describe our experiences with progress testing in a medical school in Mozambique since its establishment in 2001, specifically focusing on test acceptability, formative educational impact, test validity and test reliability. After 7 years of experience, we think that the conclusion is justified that the progress testing can be a feasible and effective assessment instrument even in a resource poor setting. Institutional collaboration is important to guarantee test quality and sustainability.

Medical Curricula on Intimate Partner Violence in Mozambique.

INTRODUCTION: The aim of the study described in this paper is to screen medical curricula in relation to the attention paid to intimate partner violence, by applying a framework derived from the international literature. MATERIAL AND METHODS: We screened curricula of five Mozambican medical schools based on a state-of-the-art intimate partner violence curriculum framework. The latter framework was based on a review of the literature. RESULTS: Few medical schools of Mozambique could be identified addressing intimate partner violence in their curriculum. When tackled, intimate partner violence content is mostly dealt within the context of Obstetrics and Gynaecology, Community Health and Forensic Medicine rotations. Intimate partner violence contents are integrated as stand-alone modules in some specific subjects. In none of the schools, specific teachers teaching intimate partner violence could be identified. No time allocation was specified to address the topic; no teaching and learning strategies could be identified invoking awareness or supporting basic knowledge acquisition; additionally, hardly any information about related assessment methods was found. Only in one medical school was the subject part of the formal curriculum. DISCUSSION: Intimate partner violence content is hardly and inconsistently addressed. The limited intimate partner violence content tracked in the Mozambican medical schools' curricula, mainly addresses violence in general, for instance as identified in Orthopaedics or Surgery contexts and sexual violence in Obstetrics and Gynaecology. The inclusion of elements of intimate partner violence in the curriculum remains restricted, questioning the impact of medical education of future practitioners' competencies. CONCLUSION: Critical changes are needed in medical curricula to match the current epidemiology of intimate partner violence in Mozambique.

Introdução: O objetivo do estudo descrito neste artigo foi o de examinar os currículos de medicina quanto à atenção dada aos conteúdos sobre a Violência Perpretada pelo Parceiro Íntimo em Moçambique, aplicando uma ferramenta de comparação derivada da literatura internacional. Material e Métodos: Examinámos os currículos de cinco escolas médicas moçambicanas com base numa estrutura curricular da Violência Perpretada pelo Parceiro Íntimo de última geração. A ferramenta de comparação foi baseada numa revisão da literatura anterior. Resultados: Poucas escolas de medicina de Moçambique podem ser identificadas abordando a Violência Perpretada pelo Parceiro Íntimo no seu currículo. Se abordada, a Violência Perpretada pelo Parceiro Íntimo é mais tratada no contexto de Ginecologia e Obstetricia, Saúde Comunitária e Medicina legal. Os conteúdos da Violência Perpretada pelo Parceiro Íntimo são integrados como módulos autónomos em algumas disciplinas específicas. Nenhum dos curriculos identificou professores específicos que leccionam Violência Perpretada pelo Parceiro Intimo. Não foi especificada a alocação de tempo para abordar o tópico; estratégias de ensino e aprendizagem, sensibilização e aquisição de conhecimentos básicos; e dificilmente informação sobre métodos de avaliação específicos. Apenas numa escola de medicina, o assunto fazia parte do currículo formal. Discussão: O conteúdo da Violência Perpretada pelo Parceiro Íntimo é dificil e inconsistentemente tratado. O conteúdo limitado da Violência Perpretada pelo Parceiro Íntimo rastreado nos currículos das escolas médicas moçambicanas aborda principalmente a violência em geral, por exemplo, conforme identificado em contextos de ortopedia ou cirurgia e violência sexual em Ginecologia e Obstetrícia. A implementação no currículo permanece restrita, questionando o impacto da educação médica nas competências dos futuros profissionais. Conclusão: São necessárias mudanças críticas nos currículos médicos para corresponder à actual epidemiologia da Violência Perpretada pelo Parceiro Íntimo em Moçambique.

Gaps in Medical Students' Competencies to Deal With Intimate Partner Violence in Key Mozambican Medical Schools.

Purpose: The researchers aimed to identify the gaps in competencies designed to help medical students to deal with Intimate Partner Violence (IPV) in key Mozambican medical schools curricula. Method: A survey was administered to 3rd and 6th-year medical students (N387), enrolled in five medical schools in Mozambique. The instrument focused on mapping students' perceived mastery of their knowledge, skills, and attitudes related to IPV. Results: In total, 387 medical students (RR 66%) participated in the survey. The overall mean perceived mastery of IPV competence was 36.18 (SD = 24.52) for knowledge, 32.01 (SD = 27.37) for skills, and 43.47 (SD = 27.58) for attitudes. Though 6th-year students reported a significantly higher mastery level, it is still below a mastery-learning benchmark of 80%. Conclusions: Medical students report critically low levels in their mastery of IPV- related competencies. This implies a need for a more comprehensive approach to developing knowledge, skills, and attitudes to deal with the victims of IPV.