Overcoming constraints of scaling: Critical and empirical perspectives on agricultural innovation scaling.

Scaling is a ubiquitous concept in agricultural research in the global south as donors require their research grantees to prove that their results can be scaled to impact upon the livelihoods of a large number of beneficiaries. Recent studies on scaling have brought critical perspectives to the rather technocratic tendencies in the agricultural innovations scaling literature. Drawing on theoretical debates on spatial strategies and practical experience of agricultural innovation scaling in Ethiopia, this paper adds to the current debate on what constitutes scaling and how to overcome critical scaling constraints. The data for the paper came from a qualitative assessment using focus group discussions, key informant interviews, and document analysis on scaling work done in Ethiopia by a USAID-funded research for development project. The paper concludes with four broad lessons for the current understating of agricultural innovation scaling. First, scaling of agricultural innovations requires a balanced focus on technical requirements and associated social dynamics surrounding scaling targets, actors involved and their social relations. Second, appreciating the social dynamics of scaling emphasizes the fact that scaling is more complex than a linear rolling out of innovations towards diffusion. Third, scaling may not be strictly planned; instead, it might be an extension of the innovation generation process that relies heavily on both new and long-term relationships with key partners, trust, and continuous reflection and learning. Fourth, the overall implication of the above three conclusions is that scaling strategies need to be flexible, stepwise, and reflective. Despite the promises of flourishing scaling frameworks, scaling strategies it would appear from the Africa RISING experience that, if real impact is to be achieved, approaches will be required to be flexible enough to manage the social, processual and emergent nature of the practice of scaling.

Research update: The relation between ME/CFS disease burden and research funding in the USA.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating, chronic, multisystem disease that affects an estimated 1 to 2.5 million Americans. It has no widely accepted biomarkers and no FDA-approved treatment. ME/CFS has traditionally been one of the lowest funded diseases by the United States National Institutes of Health (NIH). OBJECTIVES: We provide here an update to our 2016 article, which estimated the disease burden of ME/CFS in the United States in 2013 and its relation to NIH's 2015 analysis of research funding and disease burden. This update incorporates more recent burden data from 2015 and funding data from 2017. METHODS: We perform a regression analysis on funding versus disease burden to determine 2017 funding levels that would be commensurate with burden. Burden figures for 2017 are estimated using population-based extrapolations of earlier data. RESULTS: We find the disease burden of ME/CFS is double that of HIV/AIDS and over half that of breast cancer. We also find that ME/CFS is more underfunded with respect to burden than any disease in NIH's analysis of funding and disease burden, with ME/CFS receiving roughly 7% of that commensurate with disease burden. CONCLUSIONS: To be commensurate with disease burden, NIH funding would need to increase roughly 14-fold.

Where do we go from here? - Opportunities and barriers to the career development of trial managers: a survey of UK-based trial management professionals.

BACKGROUND: Clinical trials commonly have a dedicated trial manager and effective trial management is essential to the successful delivery of high-quality trials. Trial managers have diverse experience and currently there is no standardised structured career pathway. The UK Trial Managers' Network (UKTMN) surveyed its members to understand what is important to them with respect to career development since this would be important in the development of any initiative intended to develop a skilled workforce. METHODS: We conducted an online survey of UKTMN members, who are trial management professionals, working on academic-led trials in the UK. Members were asked what they perceive as opportunities and barriers to career development. Two reminders were sent to facilitate completion of the survey, and responders were offered the opportunity to enter a prize draw for waived fees at the UKTMN annual meeting. Data were analysed descriptively by using Stata (version 15.1), and free-text responses were reviewed for themes. RESULTS: The survey was sent to 819 UKTMN members; 433 responses were received, although 13 were from non-UKTMN members; thus 420 respondents' data were included in analyses. Respondents were representative of UKTMN membership; however, more responses were received by trial managers based in registered clinical trials units (CTUs). The top three opportunities for career development were (i) training, (ii) helping design trials and (iii) undertaking relevant qualifications. The top three barriers were (i) funding, (ii) few opportunities to get involved in development activities aside from managing a trial and (iii) unclear organisational career pathway. Almost all respondents (401/420, 95.4%) considered career development either very or quite important. Although all respondents had a day-to-day role in managing trials, there was huge disparity between job titles. CONCLUSION: Career development is important to trial managers yet there is a lack of a structured pathway. The enablers and disablers to career development for trial managers should be clearly considered by the clinical trial community and, in particular, employers, sponsors and funders in order to develop a highly skilled workforce of trial managers, who are key to the delivery of trials.

A scoping review examining funding trends in health care professions education research from Taiwan (2006-2017).

BACKGROUND: Traditionally health care professions education research (HCPER) is poorly funded, despite it being key to success. PURPOSE: This unique study maps HCPER evolution within a single country during a period when significant national governmental HCPER funding is introduced. METHODS: A scoping review method examined Taiwan's HCPER landscape across 12-years. Literature searches across four databases (OVID Medline; Scopus; Web of Science; the Airiti Library), a manual scan of HCPE journals and hand searches. Endnote and ATLAS.ti managed the data. Demographic and content codes were developed. PRISMA guidelines are used. DISCUSSION: One thousand four hundred and ten articles across 310 journals, with a steady rise in funded studies. Science/Social Science Citation Index and English language publications increased. Nursing Students/Nurses and Medical Students/Physicians are the most common populations. Significant associations with funding was found for indexed and English language publications. National funding influenced quality and local funding positively. CONCLUSION: Caution around local vs. global needs is highlighted and national funding policies for HCPER are advocated.

US Governmental Spending for Disaster-Related Research, 2011-2016: Characterizing the State of Science Funding Across 5 Professional Disciplines.

OBJECTIVE: Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management. METHODS: An online key word search was performed using the website, www.USAspending.gov, to identify federal awards, grants, and contracts during 2011-2016. A panel of experts then reviewed each entry for inclusion. RESULTS: The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years. CONCLUSION: US federal funding for disaster-related research is limited and highly variable during 2011-2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.

Governance and Health Aid from the Global Fund: Effects Beyond Fighting Disease.

BACKGROUND: The Global Fund to Fight AIDS, Tuberculosis and Malaria has proven highly effective at fighting the world's major killers. Strong governance and robust development institutions are necessary, however, for improving health long-term. While some suggest that international aid can strengthen institutions, others worry that aid funding will undermine governance, creating long-term harm. The Global Fund is a unique aid institution with mechanisms designed to improve transparency and accountability, but the effectiveness of this architecture is not clear. OBJECTIVES: This study seeks evidence on the effects of Fund financing over the past 15 years on national governance and development. METHODS: A unique dataset from 112 low- and middle-income countries was constructed with data from 2003 to 2017 on Global Fund financing and multiple measures of health, development, and governance. Building a set of regression models, we estimate the relationship between Fund financing and key indicators of good governance and development, controlling for multiple factors, including the effects of other aid programs and tests for reverse causality. FINDINGS: We find that Global Fund support is associated with improved control of corruption, government accountability, political freedoms, regulatory quality, and rule of law, though association with effective policy implementation is less clear. We also find associated benefit for overall adult mortality and human development. CONCLUSION: Our data are not consistent with recent claims that aid undermines governance. Instead our findings support the proposition that the Global Fund architecture is making it possible to address the continuing crises of AIDS, tuberculosis, and malaria in ways that improve institutions, fight corruption, and support development. Amidst the complex political economy that produces good governance at a national level, our finding of a beneficial effect of health aid suggests important lessons for aid in other settings.

Scope and magnitude of private sector financing and provision of immunization in Benin, Malawi and Georgia.

BACKGROUND: Little is known about the role of private sector providers in providing and financing immunization. To fill this gap, the authors conducted a study in Benin, Malawi, and Georgia to estimate (1) the proportion of vaccinations taking place through the private sector; (2) private expenditures for vaccination; and (3) the extent of regulation. METHODS: In each country, the authors surveyed a stratified random sample of 50 private providers (private for-profit and not-for-profit) using a standardized, pre-tested questionnaire administered by trained enumerators. In addition, the authors conducted 300 or more client exit interviews in each country. RESULTS: The three countries had different models of private service provision of vaccination. In Malawi, 44% of private facilities, predominantly faith-based organizations, administered an estimated 27% of all vaccinations. In Benin, 18% of private for-profit and not-for-profit facilities provided vaccinations, accounting for 8% of total vaccinations. In Georgia, all sample facilities were privately managed, and conducted 100% of private vaccinations. In all three countries, the Ministries of Health (MoHs) supplied vaccines and other support to private facilities. The study found that 6-76% of clients paid nominal fees for vaccination cards and services, and a small percentage (2-26%) chose to pay higher fees for vaccines not within their countries' national schedules. The percentage of private expenditure on vaccination was less than 1% of national health expenditures. The case studies revealed that service quality at private facilities was mixed, a finding that is similar to those of other studies on private sector vaccination. The three countries varied in how well the MoHs managed and supervised private sector services. DISCUSSION/CONCLUSION: The private sector plays a growing role in lower-income countries and is expanding access to services. Governments' ability to regulate and monitor immunization services and promote quality and affordable services in the private sector should be a priority.

High risk device registries: Global value, costs, and sustainable funding.

BACKGROUND: Well-designed implant registries have been shown to be a worthwhile investment, from both a health and economic perspective. However, many registries do not attain desirable capture rates or lack sufficient funding, potentially leading to premature termination. This study aims to provide information about rarely discussed, yet pivotal topics regarding the long-term survival of implant registries, focusing on costs, funding models, and the role of stakeholders. METHODS: Worldwide, relatively recently developed breast device (BD) registries were compared to long-standing, orthopaedic (OD) and cardiovascular device (CD) registries. A standardised questionnaire was sent to the registries' designated representatives with key positions, discussing start-up costs, costs of maintenance, value of investment, governance, stakeholders, funding, and sustainability. RESULTS: Thirteen registries were included, originating from nine countries (seven BD registries, five OD registries, one CD registry). In general, start-up costs were comparable, and younger registries were more expensive to maintain. Numerous stakeholders showed interest in registry outcomes. However, only 50% of the registries reported a sustainable funding structure. CONCLUSION: This study provides a global perspective on implantable device registries. All registries provided important information, serving three unique purposes by evaluating the quality of healthcare provided, the quality of all registered devices, and processing recall information. Yet, only half of the registries were certain of sustainable funding, and thus their future existence. It is of utmost importance to bring this to the attention of all parties involved.

An Analysis of Accreditation and Its Impact on Receiving Funding in Mental Health Hospital.

This paper examines the accreditation of mental health facilities and sources of funding. The funding sources examined are Medicare, Medicaid, Veterans Administration, private insurance, and client fees. Other factors included are the type of ownership of the facility. The conclusion is that accreditation is important. Different accreditations are important for different funding sources. The most important accreditations are state accreditations. Type of ownership is important, but relatively the least important.

Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice.

BACKGROUND: In international studies, greater investment in primary health care is associated with improved population health outcomes. AIM: To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. DESIGN AND SETTING: Retrospective cross-sectional study of general practices in England, 2014-2015. METHOD: Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. RESULTS: Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. CONCLUSION: Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.

Mapping of health research funding in India.

BACKGROUND.: We aimed to estimate the total annual funding available for health research in India. We also examined the trends of funding for health research since 2001 by major national and international agencies. METHODS.: We did a retrospective survey of 1150 health research institutions in India to estimate the quantum of funding over 5 years. We explored the Prowess database for industry spending on health research and development and gathered data from key funding agencies. All amounts were converted to 2015 constant US$. RESULTS.: The total health research funding available in India in 2011-12 was US$ 1.42 billion, 0.09% of the gross domestic product (GDP) including only 0.02% from public sources. The average annual increase of funding over the previous 5 years (2007-08 to 2011-12) was 8.8%. 95% of this funding was from Indian sources, including 79% by the Indian pharmaceutical industry. Of the total funding, only 3.2% was available for public health research. From 2006-10 to 2011-15 the funding for health research in India by the three major international agencies cumulatively decreased by 40.8%. The non-industry funding for non-communicable diseases doubled from 2007-08 to 2011-12, but the funding for some of the leading causes of disease burden, including neonatal disorders, cardiovascular disease, chronic respiratory disease, mental health, musculoskeletal disorders and injuries was substantially lower than their contribution to the disease burden. CONCLUSION.: The total funding available for health research in India is lower than previous estimates, and only a miniscule proportion is available for public health research. The non industry funding for health research in India, which is predominantly from public resources, is extremely small, and had considerable mismatches with the major causes of disease burden. The magnitude of public funding for health research and its appropriate allocation should be addressed at the highest policy level.

Análise da Política de Educação Permanente do SUS (PEPS) implementada pelas Secretarias Estaduais de Saúde (SES) / Analysis of the SUS Permanent Education Policy (PEPS) implemented by the State Health Secretariats (SES)

INTRODUÇÃO: A implementação das políticas públicas de recursos humanos em saúde, na perspectiva de um sistema político democrático no Brasil contemporâneo, vem colocando em pauta a necessidade de entender o binômio trabalho e educação, sob um novo prisma. Em geral, as interpretações sobre essa dinâmica, no que se refere à política de educação permanente dos trabalhadores da saúde, têm focado a educação como eixo transformador e como estratégia mobilizadora de recursos e poderes OBJETIVO: Objetivo geral Analisar o papel das CIES no desenvolvimento das politicas de educação permanente implementadas pelas secretarias estaduais de saúde, de forma a subsidiar gestores na implementação da política de educação permanente para os trabalhadores do SUS. Objetivos específicos Analisar o papel das CIES nas ações de EP dos estados; Identificar as ações de educação permanente desenvolvidas nas SES; Identificar o público alvo das ações de EP; Levantar os recursos financeiros destinados à EP; Identificar os mecanismos de avaliação e monitoramento das ações de EP; Conhecer, a partir da visão dos gestores, os limites e possibilidades das ações de EP nas SES. MATERIAL E MÉTODO: Adicionalmente, destaca-se Que é uma pesquisa de caráter multicêntrica que envolveu pesquisadores inseridos em seis Centros de Pesquisa: Estação de Trabalho da. Rede Observatório de Recursos Humanos em Saúde (ObservaRH/IMS/UERJ); Centro de Pesquisas Ageu Magalhães (CPqAM) da Fundação Oswa ldo Cruz (FIOCRUZ), o Núcleo de Estudos de Saúde Coletiva (NESC) da Universidade Federal do Rio Grande do Norte (UFRN), o Instituto de Saúde Coletiva da UFBA e o Núcleo de Pesquisas em Política, Gestão e Avaliação em Saúde (Nupgasc) da Universidade Federal do Espírito Santo (UFES), sendo a coordenação geral sob responsabilidade do primeiro centro. O desenho da pesquisa é de natureza qualitativa, voltada para avaliação de processo e de estrutura. O foco da avaliação foi dirigido para os condicionantes institucionais e operacionais que orientam o desenvolvimento da área de gestão da educação. Buscou-seidentificar os fatores e situações que facilitam ou dificultam a consecução das ações inerentes a esta área. CONCLUSÃO: Pela observação dos aspectos analisados, reconhece-se limites na identificação das ações de EPS desenvolvidas no âmbito das SES. As diretrizes nacionais da PNEPS postas constituem um processo, sem dúvida, inovador, mas sua implementação nas estruturas estaduais de saúde ainda tem um longo caminhar.