Athena Sustainable Materials Institute

Introduction Midwives play a pivotal role in maternal health, providing essential care that spans the continuum of pregnancy, childbirth, and the postpartum period. Nevertheless, they are frequently absent from policy dialogue, which prevents their voices and expertise from influencing healthcare planning and policymaking. Providing career opportunities for midwives and increasing their participation in leadership roles are potential strategies to promote increased availability and may contribute to enhanced quality of maternal health care. This thesis aims to gain insights into if and how training programmes and training institutions influence midwives’ careers, and consequently their distribution in Mali. The main research question of this thesis was: How do changes in midwifery education programmes influence midwives’ careers in maternal health in Mali? Study design and methods The research for the thesis used a case study approach employing mixed method research with both qualitative and quantitative data collection methods, as well as a literature and document review. Key Findings The thesis is divided into two parts. Part 1 is a situation analysis regarding midwives’ existing employment situation, particularly in rural areas and primary-level care services. Part 2 focuses on the influence of improvements in training programmes. In general, our findings related to Part 1 – the situation analysis – indicated midwives’ disaffection from the rural environment and first-level services. We also identified the important roles of personal characteristics, professional aspirations and career development, and working conditions in their decision-making. They are driven by their ambitions and are therefore willing to take more responsibility for their career development. The results of the study on the career trajectory of midwives showed that among our respondents, very few moved up within the health sector hierarchy (vertical mobility). Opportunities to obtain managerial positions, and therefore involvement in policy decisions including sexual, reproductive, maternal, neonatal and adolescent health (SRMNAH) policymaking, were low. The most prevalent mobility among our sample of midwives was horizontal, involving moving between equivalent posts in different structures. Gender was found to play a significant role in midwives' ability to move for work, impacting on their horizontal physical mobility. The organisation of training programmes and the location of training institutions have an impact on midwives’ career choices and working environments. The probability of choosing to work in rural areas or to stay employed in a rural area was found to be enhanced by the notion of a ‘rural pipeline’. The results of Part 2 of the research showed that the changes in education programmes had an influence on the career prospects of midwives. The content, the formulation and the adoption process of policy changes in training programmes resulted in fewer employment opportunities for graduates due to non-adherence to, and non-appropriation of, the policy by relevant stakeholders. On the other hand, the provision of training at the Master’s level offered greater career perspectives for some midwives. The acquisition of new skills in research, management and evaluation allowed for professional development perspectives, the absence of which is seen as one of the main obstacles to motivation and retention of midwives in the SRMNAH field. This study also highlights the need to integrate changes in training programmes into a broader human resource development perspective, aiming to respond to the needs of the health system in addition to the personal needs of the health workers. Conclusion Alterations to training programmes can impact the careers of midwives in Mali. However, for these changes to be effective, it is essential that the Ministry of Health is involved in the development and accreditation of training programmes. This ensures that the training programmes align closely with the current health needs and policies.

In decision-making about epidemic management, experts and policymakers in governmental institutions face the challenge of balancing numerous values, needs and interest. These decisions are complex, and have to be made within a context of uncertainty, public unrest and limited time. Despite the potential value of public engagement, the perspectives of the publics are limitedly integrated in decisions about epidemic management. Publics possess unique experiences, concerns, needs and ideas that can aid in the complex trade-offs at certain times in epidemics. Furthermore, engaging the publics can enhance their understanding of decision-making processes, and possibly even garner public support for these decisions and trust in decision-making institutions. Up until now, publics have for example supported response activities in epidemic management such as surveillance, improvement of communication campaigns or the execution of restriction measures. Yet, the structural integration of public values, needs and experiences into the development of epidemic management strategies has not been realized. This raises uncertainties about the feasibility and methodology of incorporating public engagement in epidemic management. The primary objective of this thesis was to explore whether and how public engagement can be integrated into decision-making about epidemic management, using the COVID-19 epidemic as a case.

We are increasingly confronted with complex societal issues such as climate change or social segregation. Higher education institutes (HEIs) have a crucial role in addressing such issues as part of their so-called third mission activities. In addition to the more market-driven forms of (technological) knowledge transfer, these complex issues require collaborative processes in defining and addressing their dynamic nature. The thesis focuses on engaged education within HEIs, as way to giving meaning to these collaborative processes through community engagement. To gain more insight into the implementation and sustainable embedment of such practices we aim to answer the following research question; How to embed engaged education within HEI, in order to contribute effectively to addressing (complex) societal issues? Our approach takes a multi-level perspective, building on the framework of Bogel et al. (2019), who combine transition studies and organisational change management. Through this framework, we allow for an explicit analysis of the role of individuals at the micro level but also consider organisational, meso-level processes when embedding engaged education. We conducted a reflection stream together with practitioners in order to gain insights into their rationales for embedding engaged education. Moreover, a theoretical stream broadly explored embedding engaged education at the individual course (micro) level as well as at the organisational (meso) level. Finally, two case studies, using an action–research approach, were conducted to gain insights into cross-disciplinary approaches for addressing complex societal issues through engaged education. Through these studies we explored systematic strategies and cross-disciplinary approaches for embedding engaged education to effectively address (complex) societal issues. Our findings show the potential of engaged education to centralise community values, needs and interests and thereby increase HEIs’ societal impact. We outline some of the tensions that can arise between individual action and organisational practices when embedding engaged education that centralise community engagement. To deal with these tensions, we describe systematic strategies for embedding engaged education for addressing societal issues at the individual course or micro level, as well as at the organisational meso level. From this we distil two guiding principles that we deem crucial when centralising community engagement as part of engaged education, namely catering for 1) continuous faculty, community and student involvement and 2) flexibility and continuity of engaged education activities. In relation to these guiding principles, we emphasise the importance of individual roles of faculty, community stakeholders and students at the micro level, but also recognise that the process of embedding engaged education, by definition, cannot rely solely on them. Changes in the organisational culture and in its policies and practices at the meso level are essential. Alignment between micro- and meso-level practices, through these guiding principles, can contribute to the institutional coherence needed to centralise community values, needs and interests. Building on this notion, we propose two concrete cross-disciplinary approaches to facilitate engaged education for addressing complex societal issues. Given their faculty-spanning nature these approaches position themselves as ‘transition initiatives’ at the meso level, while also connecting to the micro level, thereby facilitating the process of institutional coherence. We outline how such transition initiatives might contribute to transformation within and beyond individual HEIs. We believe that this thesis contributes to placing more emphasis on societal engagement, advocating for more intense involvement of community stakeholders within education. In this way, we provide valuable insights into how HEIs can purposely give meaning to their third mission activities and make societal impact through engaged education.

BackgroundsGlobally, the most rural healthcare systems are lagging behind those of urban healthcare systems. Especially in rural and remote areas, the essential resources to provide principal health services are inadequate. It is purported that physicians have an important role in healthcare systems. Unfortunately, there is a paucity of studies on physician leadership development in Asia, especially on how to enhance physician leadership competencies in rural and remote low-resource settings. This study aimed to investigate doctors’ perceptions of existing and needed physician leadership competencies based on their experiences in primary care settings in low-resource rural and remote areas are in Indonesia.MethodsWe performed a qualitative study with a phenomenological approach. Eighteen primary care doctors, who worked in rural and remote areas of Aceh, Indonesia, purposively selected, were interviewed. Prior to the interview, participants were asked to select the top-five skills they deemed most essential for their work based on the five domains of the ‘Lead Self’, ‘Engage Others’, ‘Achieve Results’, ‘Develop Coalitions’ and ‘Systems Transformation’ (LEADS) framework. We then performed a thematic analysis of the interview transcripts.ResultsWe identified the following qualities a good physician leader in low-resource rural and remote settings should possess: (1) cultural sensitivity skills; (2) a strong character that includes courage and determination; and (3) creativity and flexibility skills.ConclusionsLocal cultural and infrastructural factors create a need for several different competencies within the LEADS framework. A profound amount of cultural sensitivity was considered the most important in addition to the ability to be resilient, versatile and ready for creative problem-solving.

This study identifies microbial guilds associated with mild or severe cases of COVID-19, and uses ML to predict the clinical outcome of SARS-COV-2 infection in other cohorts based on the 2 guilds. Reviewers encourage decision-makers to consider the claims potentially actionable.

Purpose: This research aims to explore the relationship between pre-service preschool teachers' interest and career choice satisfaction, and to provide a basis for schools and teachers' two-way selection of preschool teacher positions. Methods: Using the Teacher Interest Scale (TIS) and the career choice satisfaction subscale in the FIT-Choice scale, using SPSS to conduct descriptive statistics and inferential analysis on the data of 212 pre-service preschool teachers in local undergraduate colleges. Results: The subject interest of preservice preschool teachers was significantly positively correlated with didactic interest and educational interest; educational interest was significantly positively correlated with didactic interest and career choice satisfaction.

Using Ghana and Ethiopia as case studies, this chapter examines the teaching and learning about sex and sexuality at basic, secondary, and university levels. It explores whether teaching and learning about sex and sexuality changes as students advance to subsequent levels in the education system, that is, from primary to secondary and tertiary levels of education. The role of the gender composition of the class, and its effect on class atmosphere and level of interaction emerged as an important theme. The discussion of key themes emerging from the data is structured into two key sections: silences, role of culture, language, and lexical choices; and class/lecture room atmosphere, sex composition, and gender dynamics. Awareness of the shortcomings of abstinence based approaches has led to a growing support for more comprehensive forms of sexuality education approaches.

We propose a Responsible Research and Innovation (RRI) framework to improve the alignment between mind, brain, and education (MBE) research, the educational practice, and other societal stakeholders. RRI is an approach that has successfully been used in different research fields, but not yet in MBE research. After substantiating the need for, and possibilities of using this framework within MBE research, we report a case study to demonstrate the feasibility and benefits of RRI within an MBE context. This case study entails developing an educational intervention to improve learners’ sense of agency regarding their own learning processes using neurofeedback. Using RRI, we found that societal stakeholders (teenagers, parents, and teachers) anticipate different potential impacts of this neurotechnology-based intervention than researchers did, enabling us to adapt the intervention according to these perspectives. This example demonstrates that RRI enables researchers to be reflexive and responsive to the stakeholders needs and values, to ultimately improve the educational and societal value of MBE research.

The pan-Canadian Pharmaceutical Alliance (pCPA) was established in 2010 to negotiate confidential prices for drugs coming forward from Canada's centralized health technology assessment (HTA) agency reviews, on behalf of the participating public drug plans. To analyze the activities of the pCPA, to determine: alignment of HTA agency recommendations and pCPA negotiation decisions; the role of health economics in pCPA activities; and patterns of implicit prioritization. The analysis was based on the archive of drugs handled through the pCPA, as posted on its website. The period of observation was from inception to August 31, 2017. HTA recommendations were sourced from the websites of the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review. Descriptive and statistical analyses were conducted. The dataset contained 206 drug-indication pairings. There was close but imperfect alignment between HTA agency recommendations and the pCPA's decisions to negotiate; deviations occurred only with CDR-reviewed drugs. The median incremental cost-effectiveness ratio of negotiated drugs was $168K/QALY for oncology drugs, but $70K/QALY for non-oncology drugs. The time to initiate negotiations was dramatically shorter for oncology versus non-oncology drugs (mean 54 versus 263 days), and also differed between therapeutic areas at CDR. The time required for PCPA activity was surprisingly similar for drugs recommended without a price condition and for those conditional on a price reduction. These findings revealed a strong alignment between HTA recommendations and pCPA negotiations, an implicit prioritization favouring oncology drug negotiations, and an evolving role for health economics in Canada's reimbursement process.