Directorate-General for International Cooperation and Development

Abstract Introduction Healthcare worker (HCW) play a crucial role in reducing maternal and infant mortality. However, in contexts of endemic armed conflicts, such as in the Democratic Republic of Congo (DRC), these professionals must operate under extreme working conditions, which can affect the quality of care. This study aims to assess the working environment and challenges faced by maternal and neonatal HCW in the DRC. Methodology We conducted a cross-sectional study in the North and South Kivu provinces in Eastern DRC. The study primarily targeted healthcare facilities in eight health zones. An evaluation aligned with the structure/process dimensions (profile and perception of the work environment of HCW) according to Donabedian was conducted. A descriptive and comparative analysis of the HZs (using the Chi-square test and T test) was performed. Informed consent was obtained for participation in the study. Results A total of 200 HCW were enrolled in the study, 71% of whom were women, with an average age of 37.5 years. Nurses were the majority, followed by midwives, while general practitioners represented 10.67%. On average, HCW worked approximately 67 hours per week. A third of HCW did not feel well-prepared and are dissatisfied with their work environment, reporting gaps in discussions about interpersonal skills, promotion opportunities, and professional development. Disparities in treatment were observed, with notable inequalities in training, time off, work hours, function, and promotions, often exacerbated by gender. Less than 30% received bonuses, and 90% did not receive non-monetary incentives. Verbal threats and assaults, humiliations, and physical assaults from colleagues and patients were common, with a higher incidence in North Kivu. Finally, nearly a quarter of HCW felt exposed to insecurity in and around their facilities, a perception more pronounced in North Kivu than in South Kivu. Conclusion This study shows that HCW in the DRC, particularly in conflict zones, work under extremely difficult conditions, characterized by intensive hours, lack of training, professional inequalities, and high insecurity. These challenges may compromise quality of care and the well-being of providers, underscoring the urgency of strengthening their protection and support to maintain the resilience of the healthcare system.

The impact of food taboos-often because of religion-is understudied. In Ethiopia, religious fasting by Orthodox Christians is assumed to be an important impediment for the sustainable development of a competitive dairy sector and desired higher milk consumption, especially by children. However, evidence is limited. Relying on unique data, we shed light on three major issues. First, we observe that the average annual number of fasting days that Orthodox adults are effectively adhering to is 140, less than commonly cited averages. Using this as an estimate for extrapolation, fasting is estimated to reduce annual dairy consumption by approximately 12 percent nationally. Second, farms adapt to declining milk demand during fasting by increased processing of milk into storable products-fasting contributes to larger price swings for these products. We further note continued sales of milk by non-remote farmers and reduced production-by adjusting lactation times for dairy animals-for remote farmers. Third, fasting is mostly associated with increased milk consumption by the children of dairy farmers, seemingly because of excess milk availability during fasting periods. Our results suggest that fasting habits are not a major explanation for the observed poor performance of Ethiopia's dairy sector nor low milk consumption by children. To reduce the impact of fasting on the dairy sector in Ethiopia further, investment is called for in improved milk processing, storage, and infrastructure facilities.

### Summary box A secured supply of quality-assured medicines and other medical products is an essential prerequisite for universal health coverage. Unfortunately, on average one in 10 medicines do not meet acceptable quality standards in low-income and middle-income countries (LMICs).1 2 The high prevalence of poor-quality medicines in LMICs greatly depends on the globalisation of pharmaceutical production and distribution, combined with the weakness of many national medicines regulatory authorities (NMRAs).3 4 The use of non-quality-assured medicines, often undetected, causes poor case management and unfavourable medical outcomes in individual patients, while at population level, it is translated in poor control of communicable diseases, emergence of resistance to medicines and loss of trust in health systems.2 4–6 Risks are magnified by the COVID-19 pandemic, which triggered disruption of supply chains, stockouts, substandard production, falsification of repurposed medicines and irrational use of medicines.7 8 European taxpayers’ money is used to fund medical programmes in LMICs in the context of humanitarian aid and development. Medicines for these programmes are purchased either …

ObjectiveDespite a high number of the internationally produced and implemented clinical guidelines, the adherence with them is still low in healthcare. This study aimed at exploring the perspectives and experiences of senior doctors and nurses towards the barriers of adherence to diabetes guideline.SettingThe Palestinian Primary Health Care-Ministry of Health (PHC-MoH) and Primary Health Care-United Nations Relief and Works Agency for Palestine Refugees in the Near East (PHC- UNRWA) in Gaza Strip.ParticipantsIndividual face-to-face in-depth interviews were conducted with 20 senior doctors and nurses who were purposefully selected.MethodsQualitative design was employed using the theoretical framework by Cabana et al to develop an interview guide. Semi-structural and audio-recorded interviews were conducted. Data were transcribed verbatim and thematically analysed.ResultsThe key theme barriers identified by participants that emerged from the analysed data were in regard of the PHC-MoH lack reimbursement, lack of resources and lack of the guideline trustworthiness, and in regard of PHC-UNRWA the time constraints and the lack of the guideline trustworthiness. The two key subthemes elicited from the qualitative analysis were the outdated guideline and lack of auditing and feedback.ConclusionThe analysis identified a wide range of barriers against the adherence to diabetes guideline within the PHC-MoH and PHC-UNRWA. The environmental-related and guideline-related barriers were the most prominent factors influencing the guideline adherence. Our study can inform the policy makers and senior managers to develop a tailored interventions that can target the elicited barriers through a multifaceted implementation strategy.

La plupart des réformes annoncées en matière commerciale par le ­candidat Trump n’ont pas été mises en œuvre. La France peut tirer profit de l’existence de nombreux intérêts communs pour défendre sa vision d’une ­mondialisation à la fois libre-échangiste et régulée. Cependant, l’hypothèse d’un recours croissant à des mécanismes de protection et d’un rejet du multilatéralisme doit aussi être envisagée, notamment du fait de l’attitude de la Chine et de ses alliés.

This article analyzes the potential impacts of the current review of the EU budget on the Union's R&D policy. Within this process, the European Commission, with input especially from the member states, will consider as to how the EU's expenditures actually mirror the internal and external challenges of the Union. Against this background we argue that those challenges render policy change in the field of R&D policy quite likely. In order to assess the degree of potential policy change we conceptualize three scenarios that vary along the dimensions of institutional structures, processes and actor constellations.

Depuis sa création par le premier ministre Trudeau en 1968, l’Agence canadienne de développement international (ACDI) a été le principal mécanisme institutionnel par lequel le Canada a su fournir son aide au développement. Au cours des dernières années, l’ACDI a déboursé environ 80 % de toute l’aide publique au développement (APD) canadienne budgétée. Par conséquent, les tendances des politiques de l’ACDI et l’octroi de son aide jouent un rôle fondamental pour définir la collaboration interna...

The Diffuse Infrared-Background Experiment (DIRBE) on the Cosmic Background Explorer (COBE) satellite is a 10-band absolute photometer covering the wavelengths 1–300 microns using photovoltaic, photoconductive, and bolometric detectors. The input is via a 19-cm, off-axis, highly-baffled Gregorian telescope, with the detectors located at a pupil plane so they share the same field of view (0.7 × 0.7 degrees). The whole assembly is mounted inside a 1.4 K super-fluid, liquid-He dewar, which is shared with the Far Infrared Absolute Spectrometer (FIRAS) instrument. Each day half of the sky is surveyed, as the line-of-sight of the DIRBE is canted 30 degrees to the COBE spin axis. The whole sky is fully observed in 6 months, as the spin axis precesses at about 1 degree per day. At present each sky pixel has been observed at least once. The basic findings on the general brightness of the sky — Zodiacal light and galaxy — are provided, as well as a synopsis of the advantages and disadvantages associated with a space-borne observatory. The relationship of our experience and findings with respect to possible future missions and their scientific goals is presented.