2ª Conferência Nacional de Saúde das Mulheres: Saúde e Democracia / 2nd National Conference on Women's Health: Health and Democracy

O trabalho de produção deste Rádio-Livro foi desenvolvido pela leitura e cuidadosa adaptação cultural nas linguagens das diferentes expressões da arte popular sobre a 2ª Conferência Nacional de Saúde das Mulheres, conversando sobre direitos e a responsabilidade do Estado, sobre a produção da saúde e sobre as diferentes inserções que todas as mulheres têm com a saúde e que precisam ser respeitadas e atendidas com integralidade em todas as suas dimensões. O Rádio-Livro é acessado com o pensamento, com o coração e com a vontade de fazer o mundo melhor para todas as pessoas viverem e para que a saúde das pessoas e coletividades se expressem de forma mais plena. Esse material destina-se às Rádios Comunitárias e à população em geral e tem fins exclusivamente educacionais, sendo proibida a compra e a venda em qualquer circunstância.

16ª Conferência Nacional de Saúde: arte e democracia em defesa do SUS / 16th National Health Conference: art and democracy in defense of SUS

O trabalho de produção deste Rádio-Livro foi desenvolvido pela leitura e cuidadosa adaptação cultural nas linguagens das diferentes expressões da arte popular sobre a 16° Conferência Nacional de Saúde, que definiu diretrizes muito importantes para o SUS e para os governos, também sobre a vida e a democracia, nos fazendo lembrar da origem do SUS e da 8ª Conferência Nacional de Saúde. O Rádio-Livro é acessado com o pensamento, com o coração e com a vontade de fazer o mundo melhor para todas as pessoas viverem e para que a saúde das pessoas e coletividades se expressem de forma mais plena. Esse material destina-se às Rádios Comunitárias e à população em geral e tem fins exclusivamente educacionais, sendo proibida a compra e a venda em qualquer circunstância.

Quando a conferência de saúde ensina para o trabalho e para a vida: narrativas dos estudantes sobre a 16ª Conferência Nacional de Saúde / When the health conference teaches for work and for life: student narratives about the 16th National Health Conference

Em um contexto de retrocessos políticos, sociais, sanitários e civilizatórios, deparamo-nos com a 16ª Conferência Nacional de Saúde, carinhosamente apelidada de 8ª + 8, para tornar visível o encontro com a conferência-marco da reforma sanitária brasileira. Durante a conferência foi realizada a pesquisa "Saúde e democracia: estudos integrados sobre participação social na 16ª Conferência Nacional de Saúde", cujo objetivo foi analisar a participação social no processo da 16ª Conferência Nacional de Saúde em dimensões que permitissem sistematizar evidências da relevância e da abrangência do processo participativo nas etapas e atividades que a compuseram. A partir das experiências vivenciadas pelos estudantes pesquisadores, afetivamente reconhecidos como "verdinhos e verdinhas", em alusão à camiseta de cor verde que os identificava entre os participantes da 16ª CNS, elaborou-se a chamada de manuscritos que culminou neste livro. Encontram-se aqui reunidos aproximadamente 30 narrativas, somadas a alguns manuscritos feitos sob demanda dos organizadores. Agradecemos a cada uma das pessoas que ofereceu sua narrativa, a cada esforço necessário para compor uma estética capaz de dizer do lugar de aprendizagem que cada um e cada uma das pessoas que estiveram conosco nesse grande laboratório de democracia e cidadania que foi a 16ª Conferência Nacional de Saúde. E a cada leitor e leitora que, sensivelmente, compreender que cada um dos textos é um convite para a defesa do SUS, do ensino da saúde pautado pelo compromisso ético com todas as saúdes dos territórios e com o SUS como política pública.

A comparison of three types of targeted, community-based methods aimed at promoting early detection of new leprosy cases in rural parts of three endemic states in India.

BACKGROUND: India achieved elimination of leprosy nationally in 2005, but since then the number of patients with grade 2 disability at diagnosis increased steadily indicating delay in diagnosis. Therefore, there was a need for public health interventions which can increase case finding in their earlier stage. The objective of this study is to compare the effectiveness of three such community-based interventions; 1) Enhancement of community awareness on leprosy; 2) Education and motivation of "Index" leprosy cases; and 3) Involvement of Non-Formal Health Practitioners (NFHPs) to promote early detection of new cases of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Three community-based interventions were implemented between April 2016 and March 2018, embedded within the National Leprosy Eradication Program (NLEP) of India. Interventions were 1) increasing awareness through involvement of Gram Panchayat (local government) in the community regarding early signs of leprosy (Awareness), 2) providing health education and motivating newly diagnosed leprosy patients to bring suspects from their contacts (Index) and 3) training local non-formal health practitioners (NFHP). Each intervention was implemented in a group of ten blocks (sub-division of district) with an additional ten blocks as control (with no intervention). The main outcomes were number of new cases detected and number of grade 2 disability among them. They were obtained from the routine NLEP information system and compared between these interventions. On an average, there was an addition of 1.98 new cases in Awareness blocks, 1.13 in NFHP blocks and 1.16 cases in Index intervention blocks per month per block after adjusting for changes in control blocks during the same period. In terms of ratio, there was a 61%, 40% and 41% increase in case notification in awareness, Index and NFHP intervention, respectively. Overall, the percentage of grade 2 disability across intervention blocks declined. CONCLUSION: The Awareness intervention appears to be more effective in detection of new cases, compared to Index case motivation and sensitization of NFHPs. However, it is important to stress that while selecting strategies to increase early diagnosis it is important to determine, which is the most appropriate for each context or area and must be decided depending on the local context.

Conferências Nacionais de Saúde e a construção do Sistema Único de Saúde ­ SUS: uma revisão / National Health Conferences and the construction of the Single Health System- SUS: a review

O objetivo deste artigo é analisar as 13 primeiras Conferências Nacionais de Saúde, com base no princípio da participação comunitária no processo de construção do Sistema Único de Saúde (SUS). As Conferências Nacionais de Saúde no Brasil têm sido um espaço público para a construção, a organização e a implementação coletiva do SUS. Este texto analisa, por meio de revisão de outros estudos, os fatores que determinaram o sucesso do processo de participação nas conferências de Saúde e examina as origens históricas da criação do SUS no Brasil.

The aim of this article is to analyze the first 13 National Health Conferences based on the principle of community participation in the process of building the Unified National Health System (SUS). The National Health Conferences in Brazil have been a public space for the construction, organization and collective implementation of the SUS. The article analyzes, through a review of other studies, the factors that determined the success of a participatory process in the health conferences and examines the historical origins of the creation of the SUS in Brazil.

Mínima Información esencial para documentar el seguimiento de contactos y dosis única de Rifampicina (SDR) para el control de la Lepra: Guía práctica / No disponible

Hay un renovado interés en el control de la lepra mediante la búsqueda activa de casos, que cada vez más se combina con intervenciones quimioprofilácticas para intentar reducir la transmisión del Mycobacterium leprae. El Programa Profilaxis Post-Exposición a la Lepra (LPEP, en inglés) está activo en ocho países endémicos e implementa la administración de dosis única de rifampicina (SDR, en inglés) a contactos seleccionados de pacientes de lepra. LPEP ha desarrollado un sistema de vigilancia, incluyendo la obtención de datos, reportes y controles rutinarios para cada país participante. Este sistema es todavía en gran parte específico para el programa LPEP. Para facilitar la continuidad después de completar la fase del proyecto y la puesta en marcha en otros países interesados, se intenta identificar la cantidad mínima de datos para documentar adecuadamente las actividades de la búsqueda de contactos y administración SDR para el control de la lepra de forma rutinaria. Se describen cuatro indicadores para el caso índice (además de cuatro ya obtenidos habitualmente) y siete indicadores para el cribaje de convivientes/contactos vecinos y encuestas comunitarias. Se proponen dos formas genéricas para obtener toda la información relevante a nivel de campo y distrito para el seguimiento de individuos o datos si resultara necesario, facilitar directrices para desarrollar las distintas tareas, proporcionar control de calidad al registrar las cuestiones clave para valorar la SDR y facilitar poder informar. Estos impresos genéricos tienen que adaptarse a requerimientos locales en cuanto a diseño, idioma e indicadores operacionales adicionales

In leprosy control there is a renewed interest in active case finding, which is increasingly being combined with chemoprophylactic interventions to try and reduce M. leprae transmission. The Leprosy Post-Exposure Prophylaxis (LPEP) programme, currently ongoing in eight endemic countries, pilots the provision of single-dose rifampicin (SDR) to eligible contacts of leprosy patients. LPEP has developed a surveillance system including data collection, reporting and regular monitoring for every participating country. This system is still largely programm-especific to LPEP. To facilitate continuity after completion of the project phase and start-up in other interested countries, we aim at identifying the minimal set of data required to appropriately document contact tracing activities and SDR administration for leprosy control in a routine setting. We describe four indicators for the index case (plus four already routinely collected) and seven indicators for household/neighbour screening, and community surveys. We propose two generic forms to capture all relevant information required at field and district level to follow-up on individuals or data if needed, provide guidance on the sequence of tasks, provide quality control by listing key questions to assess SDR eligibility, and facilitate reporting. These generic forms have to be adapted to local requirements in terms of layout, language, and additional operational indicators

O caminho da enfermagem brasileira na luta pelo sistema único de saúde / The path of brazilian nursing in the fight for the unified health system

Objetivo: caracterizar a participação da enfermagem brasileira na luta pelo Sistema Único de Saúde. Método: estudo descritivo, documental, de abordagem qualitativa. A produção de dados foi realizada no mês de abril de 2015, através dos Relatórios das Conferências Nacionais de Saúde (1ª a 14ª) e dos números do Jornal ABEn Online (2003 a 2014). Resultados: verificou-se que a enfermagem brasileira participou da luta pelo Sistema Único de Saúde de forma expressiva, integrando-se às Conferências Nacionais de Saúde com a discussão de temáticas que contribuíram tanto para o desenvolvimento do sistema de saúde quanto para o desenvolvimento e regularização da profissão. Conclusão: busca-se contribuir para evidenciar a importância da integração da enfermagem nas lutas políticas do sistema de saúde brasileiro, incentivando, cada vez mais, a participação da categoria na consolidação de melhorias no âmbito sanitário.

Participação popular no controle da hanseníase: um desafio para o serviço de saúde / Social participation in leprosy control: a challenge for health services / Participación popular en el control de la lepra: un desafío para el servicio de salud

O objetivo do estudo foi analisar, na perspectiva de conselheiros de saúde e líderes comunitários, o processo de intervenção do serviço de saúde no controle da hanseníase. Trata-se de uma pesquisa de abordagem qualitativa, realizada em agosto de 2013, no município de Almenara, Minas Gerais. Os dados foram coletados por meio de entrevista semiestruturada com 10 conselheiros de saúde e sete líderes comunitários. O tratamento dos dados foi realizado a partir da análise qualitativa proposta por Laville e Dione. Os líderes comunitários e os conselheiros de saúde não identificam as ações realizadas pelo serviço de saúde relacionadas à hanseníase no município e não participam, individualmente ou como grupo, das atividades de controle da doença. Conclui-se que o serviço de saúde de Almenara não está sendo capaz de promover a participação social no controle dessa doença, conforme estabelecido pelo Programa Nacional de Controle da Hanseníase.

The aim of this qualitative study was to examine the process of health service intervention in leprosy control asse en by local health policy council members and community leaders. The study was conducted in August 2013 in the municipality of Almenara, Minas Gerais, Brazil. Data were collected from 10 health policy counsellors and seven community leaders using a semi-structured questionnaire. Data were analysed according to Laville and Dione’s qualitative approach. Neither the community leaders nor the health policy counsellors identified leprosy-related measures by health services in the municipality, and took no part, individually or as a group, in leprosy control activities. It was concluded that health services in Almenara are not capable of promoting social participation in leprosy control as required by the National Leprosy Control Programme.

El objetivo del estudio fue analizar desde la perspectiva de los consejeros de salud y líderes comunitarios, el proceso de intervención del servicio de salud en el control de la lepra. Se trata de una investigación de abordaje cualitativo, realizada en agosto de 2013, en el municipio de Almenara, Minas Gerais, Brasil. Se han recolectado los datos a través de entrevistas semiestructuradas con 10 consejeros de salud y siete líderes comunitarios. Se han analizado los datos por medio deanálisis cualitativo propuesto por Laville y Dione. Los líderes comunitarios y consejeros de salud no identifican las medidas adoptadas por el servicio de salud en relación a la lepra en el distrito y no participan, de forma individual o como un grupo, de las actividades de control de la enfermedad. Se concluye que el servicio de salud de Almenara no es capaz de promover la participación social en el control de la lepra, según lo establecido por el Programa Nacional de Control de Lepra.

Conferências Nacionais de Saúde e o Serviço de Ouvidoria no Brasil / National health conferences and ombusman service in Brazil

O estudo objetivou identificar, descrever e analisar o que os relatórios finais das 10 ª, 11ª, 12ª e13ª Conferências Nacionais de Saúde mencionaram sobre ouvidoria na saúde. Estudo históricodocumental,que examinou os relatórios finais das conferências mencionadas, disponíveis no sitedo Ministério da Saúde. Esses documentos foram lidos e analisados conforme sua sequênciacronológica. Os achados foram compilados e organizados em categorias de análise, empregandoseos critérios de similaridade e pertinência temática. O presente estudo apontou o conteúdo e opercurso das ações propostas pelas 10ª, 11ª, 12ª e 13ª Conferências Nacionais de Saúde para ainstitucionalização da Ouvidoria como instrumento de controle social do Sistema Único de Saúdepelos conselhos de saúde.

Selective Special Drive (SSD): an effective tool to promote new case detection through community participation--an experience during 2005-2010 in Mumbai slums.

As per the Guidelines of National Leprosy Eradication Programme (NLEP), Government of India, new case detection (NCD) in leprosy is to be promoted by voluntary reporting through Information, Education and Communication (IEC). Accordingly, in addition to the routine IEC activities, Maharashtra Lokahita Seva Mandal (MLSM) carried out Selective Special Drive (SSD) in slum pockets in Mumbai since 2005-06. The SSD methodology prescribed under Leprosy Elimination Action Program (LEAP) of ALERT-INDIA was adopted which included selection of slum pockets, identification and training of Community Volunteers (CVs), door-to-door focused IEC through CVs using standard IEC material and referral of voluntarily reported suspected cases to nearby Health Posts under General Health Services or to Leprosy Referral Centre (LRC) established through MLSM for diagnosis and treatment. During the years, 2005-06 to 2009-10, MLSM conducted five annual SSDs in 53 slum pockets having 187,391 house-holds with the total enumerated population of 882,114 of which 563,040 (63.8%) could be covered through house-to-house IEC by 772 trained CVs/CHVs. As a result, 108 new cases (PB - 79 and MB - 29) were detected with the NCD rate ranged between 13/100,000 and 34/100,000 which is much higher than the reported NCDR in Mumbai (i.e. 6/100,000). Of the new MB cases 6 were lepromatous leprosy cases. Voluntary reporting of new cases was also found to be enhanced during the subsequent period following SSD. SSD activity encourages intensified IEC with community participation and integrates General Health Services resulting into better voluntary reporting of new cases. It is, therefore recommended that the SSD with the methodology prescribed under LEAP may be considered for incorporation in NLEP.

Health reform: special report. Health reform turns two: after passage of the Affordable Care Act, the work--and the criticisms--persist.

UNLABELLED: NCSL tracks state actions on federal health reform closely. You can learn more about federal regulations, state legislation, Medicaid, insurance reform and more at www.ncsl.org/healthreform. Several NCSL health staff contributed to this package of stories related to the two-year anniversary of the Affordable Care Act. Contributors: Exchanges: job no. 1--Martha Salazar. Big changes for insurers--Richard Cauchi. Sharp divisions persist over law's future--Richard Cauchi. Transforming Medicaid--Melissa Hansen. States decided essential benefits--Richard Cauchi. PREVENTION: more than an ounce--Amy Winerfeld. Help wanted: doctors and nurses--Laura Tobler.

Transfer of disability care of leprosy to the affected persons and the community members.

Bargarh district in the western Orissa had high leprosy burden and LEPRA India supported in control activities. Its main focus was on POD care with community participation. After motivation and capacity building, it transferred the responsibility of POD care to affected persons, family, community partners and GHS staff in 2006. The effectiveness of this approach was evaluated in 2009. With personal contact responses from 112 (17%) persons with disability and 18 stakeholders were obtained. Result shows 98% affected persons are staying with family; 92% are practicing self-care; 92% felt self-care is beneficial; 57% and 36% are using commercial and MCR footwear respectively. Surgical correction of deformity is maintained in 80% of cases. Difficulty in activity and in community participation was experienced in about one third of affected persons the latter is mostly due to self stigma. The facilitators were happy with their beneficiaries.

Sustainability of integrated leprosy services in rural India: perceptions of community leaders in Uttar Pradesh.

As part of a community-based action research to reduce leprosy stigma, village committees were formed in 3 hyper endemic states of India. From a total of 10 village committees with nearly 200 members from Uttar Pradesh, a systematic random sample of 69 men and 23 women were interviewed in-depth regarding their views on sustainability of integrated leprosy services, as currently adopted. Their recommendations were also sought for further enhancement. Percentages were computed and compared for statistical significance using the z-normal test. The findings show that less than 50% of the respondents were confident that the present trend in voluntary early reporting for MDT and management of complications was adequate to sustain the integrated leprosy services. There were no differences by men or women members and they felt that lack of proper facilities, training and orientation of staff are most influencing factors. Many suggestions were given for improving the sustainability.

Lessons from the evolution of a CBR programme for people affected by leprosy in Northern Nigeria.

OBJECTIVE: This paper reviews the 13-year evolution of the social economic activities in Northern Nigeria from a welfare-oriented to a community-centred programme for people affected by leprosy. DESIGN: The review relied on the analysis of policy and strategy documents, programme guidelines and statistical and evaluation reports. RESULTS: Findings revealed that the transformation among other things, demanded formulation of new programme policies and guidelines; and staff training in CBR principles and practice. Findings also showed that adopting CBR principles and community development projects can stimulate improvements in living conditions, self-esteem and acceptance of people affected by leprosy into the community. Regardless of becoming a more inclusive and participatory programme wherein people affected by leprosy contribute to programme implementation and evaluation; groups affected by leprosy remain economically dependent on the programme and partnership mobilisation is weak. This explains why the priorities for sustaining the processes and impacts generated through CBR in northern Nigeria include: i) empowering groups to access mainline services; ii) working through partners to implement CBR and attract extra funding/ownership of interventions, and iii) promoting human rights of people affected by leprosy and working for a barrier free environment. CONCLUSIONS: In the absence of an agreeable understanding and method of assessing sustainability in CBR, we recommend the field-testing of a proposal for evaluating sustainability, to determine its utility in different contexts. Such field-tests have the potential of influencing policy and practice in the future.

Comunicação comunitária e saúde: a possibilidade de sintonia em uma só estação rumo à democratização dos espaços da mídia e do SUS / Community communication and health: the ability to tune into one station in the democratization of media spaces and the Unified Health System

Comunicação e saúde no Brasil, no que se refere à sua ação política, pode ser identificada, embrionariamente, quando ainda nem se configurava como campo, quando, no relatório final de 1986 da VIII Conferência Nacional de Saúde (CNS), inclui-se como garantia do direito à saúde o “direito à liberdade, à livre organização e expressão”. A partir daí, esse campo vai acumulando forças com os movimentos sociais, culminando no relatório final da XII CNS, em 2003, onde se torna claro o reconhecimento das rádios comunitárias como instrumento de divulgação e produção de temas relacionados ao SUS.Este trabalho tem como objetivo analisar as relações que se estabelecem entre profissionais de saúde, ouvintes/usuários e comunicadores populares envolvidos com uma rádio comunitária, de modo a entender como são constituídos os nexos entre um programa de rádio sobre saúde e os imaginários desses sujeitos. Para isso, utilizou-se uma abordagem metodológica qualitativa, fazendo-se uso da etnografia e do estudo de recepção. O campo empírico se constituiu de um programa de rádio sobre saúde, o Bloco Mulher Saúde, transmitido pela rádio comunitária Rádio Comunidade FM 104,9 no município de Nova Friburgo, RJ. As discussões sobre o material pesquisado foram divididas em categorias analíticas, cuja análise gerou os seguintes resultados: a comunicação comunitária pode contribuir como mediador político-cultural na vocalização das demandas sobre saúde; existe a manutenção e reprodução do linguajar técnico hegemônico em saúde pelos médicos ao participarem de uma rádio comunitária; a comunicação comunitária pode auxiliar na construção de estratégias para ampliar o controle social no SUS.

Communication and health in Brazil, as far as its political action is concerned, can be identified, in an incipient state, in the final 1986 report of the VIII of the National Health Conference (NHC). In this report, the “right to freedom, to the free expression and social organization” is included as a guarantee to the right to health, prior to the constitution of Communication and health as a field of investigation. Since then, this field has been strengthened with social movements, in a process that culminates, in the final 2003 report of the XII NHC, with the recognition of community radios as an instrument of production and divulgation of themes related to the SUS (Brazilian Unified Health System). This study aims at analyzing the relations between health professionals, listeners/users and popular communicators within a community radio, as a means of characterizing the nexus between a radio program on health and the conceptions and/or expectations of the people involved in it. It was used a qualitative methodological approach, by making use of ethnographic and media audience methodologies. The empirical field was through a radio program about health, Block Women's Health, broadcasted by the community radio Rádio Comunidade FM 104,9 in Nova Friburgo, RJ. The data was divided into analytical categories and the analysis gave rise to the following results: the community communication can be a cultural-political mediator for the expression of the community’s demands on health; the hegemonic medical jargon is maintained and reproduced by the medical doctors who participate in a community radio; the community communication can contribute to the creation of strategies that broaden the social control of the SUS.

The participatory development of international guidelines for CBR.

PURPOSE: The CBR Guidelines are being developed by UN Agencies and civil society groups including disabled people's organisations (DPO). The aim of the CBR guidelines is to enhance the quality of life of people with disabilities including those affected by leprosy. Strong linkages between leprosy programmes and CBR will optimise the benefit of medical care and ensure leprosy-affected people access all relevant services that promote inclusion and participation. BACKGROUND: The World Health Organisation introduced the concept Community Based Rehabilitation (CBR) in the early 1980s. CBR was designed to enhance the quality of life for people with disabilities through community initiatives. To facilitate this, WHO published a CBR Manual 'Training in the community for people with disabilities' in 1989. Since then there have been many developments within and outside the disability sector. Based on these global developments and as a result of stakeholder consultation, ILO, UNESCO and WHO updated the CBR Joint Position Paper (2004) and restructured CBR as a strategy for rehabilitation, equalisation of opportunities, poverty reduction and social inclusion of people with disabilities. The purpose of this Joint Position Paper was to describe and support the concept of CBR as it is evolving, with an emphasis on human rights and a call for action against poverty. The Convention on the Rights of Persons with Disabilities aims to ensure that they enjoy human rights on an equal basis with others. Guidelines on how to implement CBR respond to the demands created by the publication of the Joint Position Paper and The Convention on the Rights of Persons with Disabilities. RESULTS: The CBR Guidelines are being developed by three UN agencies: WHO, ILO and UNESCO. It is being actively supported by 13 International Non Governmental Organisations (NGO) including Disabled People's Organisations (DPO). Over 150 experts from across the globe have contributed to the draft guidelines which are being field tested in 25 countries. The guidelines have five major components: health, education, livelihood, social and empowerment. Beside these five components, the Guidelines also focus on management of some special scenarios including CBR and HIV/AIDS, CBR and leprosy, CBR and mental health and CBR in crisis situations. The CBR guidelines also underline that people with leprosy-related disability are seen as members of the disability community in the wider context given the shared experiences and challenges. CONCLUSIONS: The CBR guidelines are an important step forward in promoting CBR as a community based inclusive development strategy. The guidelines focus on meeting basic needs, reducing poverty, accessing benefits of mainstream developmental initiatives, inclusive community and empowering people with disabilities and their families. It also focuses on implementing the Convention on the Rights of Persons with Disabilities using community-based initiatives. People with leprosy are often neglected by traditional CBR programmes. These guidelines make the case for including people with leprosy in CBR programmes and in the community.

Impact-oriented steering--the concept of NGO-IDEAs 'impact toolbox'.

The NGO-IDEAs 'Impact Toolbox' has been developed with a group of NGOs all of which are active in the area of saving and credit in South India. This compilation of methods to apply in impact-oriented steering was devised by the executive staff of the Indian partner NGOs, also known as the Resource Persons, in 2006 and tested from late 2006 to early 2007. At first glance, the approach may appear to be highly specialised and difficult to transfer. However, in fact it follows principles that can be adapted for several NGOs in other countries and in other sectors. The following article presents the concept of the NGO-IDEAs 'Impact Toolbox'.