Pact

Cardiovascular diseases, diabetes, and cancer account for 91% of all deaths in Ukraine. However, less than 40% of the population use essential health services at the primary healthcare (PHC) level, with only 9% accessing prevention services. A 2023 Community Health Needs Assessment by Pact identified hypertension, heart disease, diabetes (34-76% of respondents), and cancer (29-75%) as major health concerns, especially in rural areas, alongside risky behaviors like tobacco use, alcohol abuse, and unhealthy diets. To address this, Pact launched the Public Health System Strengthening (PHSS) Collaborative in June 2024, uniting multidisciplinary teams from nine communities across eight regions. Using a quality improvement approach, the Collaborative aims to strengthen early detection and care for hypertension, diabetes, cancer (breast, cervical, colorectal), and mental health conditions. Key questions include: 1. What proportion of the population is at risk of NCDs? 2. How can screening rates be increased? Interventions focus on raising community awareness, boosting participation in PHC screenings, and improving access to mental health services. Systems improvements, such as better data collection, streamlined processes, and digital tools for tracking individuals with NCD risk factors, support more effective service delivery. Since October 2024, family doctors have surveyed over 25,000 residents (10% of population), identifying NCD risk factors in 80%. Nurses and mobile teams extended reach into rural areas, achieving 60%-98% coverage in targeted communities. Collaboration between medical and non-medical sectors significantly improved NCD screening and risk identification. Early detection and digital innovation are critical for shifting healthcare priorities towards prevention-focused, integrated care and reducing Ukraine's NCD burden.Key messages• The PHSS Collaborative developed practical interventions to increase NCD screening and improve linkage to care in urban and rural settings, offering adaptable solutions for different contexts.• Digital tools facilitate tracking individuals with NCD risk factors and enable timely detection and follow-up.

Abstract Date Presented 04/03/2025 The SMMART Clinic offers free medical and rehabilitative services to a predominantly Hispanic and uninsured population. This presentation will explain the development of accessible patient education for mental wellness, chronic pain, and nutrition. Primary Author and Speaker: Aubrey C. Lemon Additional Authors and Speakers: Marissa Gilbertson, Kimberley Persons, Amanda Stolle Contributing Authors: Susan Alcott, Leah Eggan, Valerie Josephson, Katie Lake, Alison Tokkesdal

Abstract This chapter examines good practices in implementing effective Monitoring, Evaluation, and Learning (MEL) systems within complex international development Democracy, Human Rights, and Governance (DRG) programs, which are characterized by challenges of non‐linearity, limited evidence of theories of change, and contextual and politically contingent nature of outcomes. The chapter presents three cases of MEL systems in complex projects implemented by Pact across distinct and diverse operating contexts – Zimbabwe, Cambodia, and Somalia – to illustrate those projects’ MEL approaches that enabled continuous adaptation. The authors analyze the cases to respond to two questions: (1) What are the key elements of effective adaptive management‐focused MEL systems in complex environments? (2) What is practical guidance for designing and enabling complexity‐responsive and effective adaptive management‐focused MEL systems? The case studies illustrate three key elements: (1) Information gathering that closely links context, research, and performance data; (2) Systems for reflection that offer scheduled learning moments of varying frequency and intensity, as well as multiple feedback mechanisms; and (3) Enabling structures that promote adaptive mindsets and attitudes within project teams.

ABSTRACT This study examines how posters on an online forum discussed their own current and past decision-making in response to a celebrity health announcement. We examined messages in response to a celebrity narrative, and extracted those explicitly related to decision-making around genetic testing and preventative surgery. Using deductive coding we identified different types of decision-making narratives, and with inductive coding we examined how users discussed decision-making activities. Guided by the literature on narrative content types in decision-making, and on celebrity health narratives, we found that the celebrity decision announcement facilitated social sharing in relation to two key decision-making activities. First, identifying with the celebrity allowed people to reflect and compare their own personal health circumstances. This empowered readers to appraise and select options about their current decision-making regarding preventative surgery. Second, the announcement allowed an extension of the discussion beyond the celebrity, and acted as a catalyst encouraging other people to share their own previous decision-making experiences. These experiences contained a mix of narratives content types, and provided an opportunity for posters to evaluate their decisions, and to contribute to a repository of decision-making examples for others. Health narratives act as communication devices in decision-making, and we discuss the findings in relation to the extension of the educational and persuasive function of celebrity health narratives.

The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD), such as diabetes mellitus (DM). We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

The Ethiopian diaspora is using the Internet increasingly to reflect on its identity, to forge new communities, and to promote cultural innovation. This essay tracks the close association of information and communication technologies (ICTs) with the emergence of the Ethiopian diaspora since 1980, setting forth a series of brief case studies illustrating the role of ICTs among different Ethiopian ethnic communities. It documents the manner in which ICTs shape socialization and address questions of return to homeland; it also explores the way in which Ethiopians have exploited new media and their technical innovations. The essay concludes with an account of ways in which freedom of expression and access to technology enable diaspora Ethiopians to have public discussions and circulate critiques of Ethiopian politics and culture that could not have taken place in Ethiopia, which is not only at the bottom of the digital divide but has exercised censorship over a number of homeland Ethiopian Web sites and blogs. (16 January 2009)