RESUMO
Despite the importance of transboundary water management, cooperation mechanisms are limited, especially in the case of Mekong River basin where environmental and social aspects are threatened by recent anthropogenic pressures like hydropower development. Existing transboundary mechanism such as the Mekong River Commission (MRC) is challenged to facilitate the cooperation between riparian states. An epistemic community (EC) is considered to effectively influence international governance and is studied as part of transboundary river regimes. The existence of an MRC EC is part of that regime but understanding about its characteristics is yet limited. This research aims to fill in the gap by unraveling the main features of the EC in relation to hydropower development. We analyze shared causal beliefs and policy goals that developed in the EC framework of Haas applying literature review and semi-structured interviews of experts. Results show that the community experts share causal beliefs and policy goals only to a limited extent while disagreeing on many aspects. It resembles a "disciplined" or "professional" group rather than an EC. This suggests that the knowledge factor has not gained proper influence and attention in the region, resulting in incoherent policy advice leading to policymakers developing policies based on incomplete and fragmented knowledge. The role of the MRC in the decision-making process could become more relevant if it would facilitate the development of an EC. Bringing key stakeholders including policymakers and experts into a platform where policy goals and causal beliefs are facilitated to reach possible consensus is recommended. Narrowing the science-policy gap while acknowledging differences in interests and policy objectives is crucial to reach a sustainable transboundary management of the Mekong River given its rapid development, especially on hydropower.
Assuntos
Monitoramento Ambiental , Rios , ÁguaRESUMO
BACKGROUND: Vietnam has successfully reduced malaria incidence by more than 90% over the past 10 years, and is now preparing for malaria elimination. However, the remaining malaria burden resides in individuals that are hardest to reach, in highly remote areas, where many malaria cases are treated through the informal private sector and are not reported to public health systems. This qualitative study aimed to contextualize and characterize the role of private providers, care-seeking behaviour of individuals at high risk of malaria, as well as risk factors that should be addressed through malaria elimination programmes in Vietnam. METHODS: Semi-structured qualitative interviews were conducted with 11 key informants in Hanoi, 30 providers, 9 potential patients, and 11 individuals at risk of malaria in Binh Phuoc and Kon Tum provinces. Audio recorded interviews were transcribed and uploaded to Atlas TI™, themes were identified, from which programmatic implications and recommendations were synthesized. RESULTS: Qualitative interviews revealed that efforts for malaria elimination in Vietnam should concentrate on reaching highest-risk populations in remote areas as well their care providers, in particular private pharmacies, private clinics, and grocery stores. Among these private providers, diagnosis is currently based on symptoms, leaving unconfirmed cases that are not reported to public health surveillance systems. Among at-risk individuals, knowledge of malaria was limited, and individuals reported not taking full courses of treatment, a practice that threatens selection for drug resistance. Access to insecticide-treated hammock nets, a potentially important preventive measure for settings with outdoor biting Anopheles vectors, was also limited. CONCLUSIONS: Malaria elimination efforts in Vietnam can be accelerated by targeting improved treatment, diagnosis, and reporting practices to private pharmacies, private clinics, and grocery stores. Programmes should also seek to increase awareness and understanding of malaria among at-risk populations, in particular the importance of using preventive measures and adhering to complete courses of anti-malarial medicines.
Assuntos
Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Adulto , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , Vietnã , Adulto JovemRESUMO
Efforts on socio-hydrology science have been promoted to solve challenges faced by contemporary water management. This study aims to better understand the co-evolution of human-water systems in floodplains. Specifically, farmers' opinions on flooding, dike effects, and living conditions in different dike systems in the Vietnamese Mekong Delta floodplain are compared to explore possible connections between human perceptions and dike development processes by employing in-depth interviews of 7 officials and oral surveys of 100 farmers supported by a literature review. Local specific contexts have resulted in various dike systems. One mixed-low-dike-dominant, two mixed-high-dike-dominant, and one only-high-dike zones are found in the research area. High dikes have been operating in an ad hoc response to short-term demands in the mixed-dike zones while strictly following a provincial schedule in the only-high-dike zone. The Fisher-Freeman-Halton test was used to compare the farmers' opinions on diverse questions between the zones. Dike development processes are suggested to influence livelihood, transportation, perceived flood peak changes and perceived causes for declining fish stocks. Although it remains challenging to directly attribute these differences to the dike development processes themselves, a new interrelated dike-flood-livelihood feedback loop is proposed for floodplains. Insights obtained are expected to support decision makers formulating tailored climate change adaptation policies to the different socio-hydrological zones. Our findings also contribute to the current understanding of international scientific communities on the human-water system and provide materials to further develop socio-hydrological models that strengthen our predictive capability on how the complex system evolves in floodplains.