Evidence-based public health: what does it offer developing countries?

The global burden of disease and illness is primarily situated in developing countries. As developing countries have limited resources, it is particularly important to invest in public health and health promotion strategies that are effective. Systematic reviews are central to evidence-based public health and health promotion practice and policy. This paper discusses issues surrounding the relevance of evidence-based public health and systematic reviews to the health of developing countries. It argues that there is a lack of systematic reviews relevant to the health priorities of developing countries; many interventions reviewed can not be implemented in resource-poor situations; and, a limited amount of primary research is conducted in developing countries. The paper further argues that improvements in public health are determined not only by effective health services and interventions, but through an approach that includes other sectors and influences broader structural and systematic barriers to health. Given the social complexity of human development, and the inter-sections amongst different development goals, there is no question that gains in developing country public health are unlikely to emerge from systematic reviews alone, but will require decisions about inter-sectoral collaboration and social policy initiatives. Nonetheless, evidence around intervention effectiveness has an important role to play in addressing health priorities in developing countries and resource-poor areas. The public health evidence base urgently needs strengthening, with dedicated effort towards increasing the relevance of primary evidence and systematic reviews.

Cosmopolitanism, identity and recognition

An application of the social theory of Axel Honneth to global justice, arguing that development goals must include provision for the intersubjective recognition required for identity formation. In the disciplines of Political Philosophy and International Relations cosmopolitanism is often defined as the view that all people, no matter their national, ethnic or religious backgrounds and no matter what their gender, have an equal moral status. The most telling enunciation of this view is the United Nations’ Universal Declaration of Human Rights. However, the focus that is given to rights and a global form of legal equality by this document and by such theorists as John Rawls is not rich enough to capture all of the ethical demands that global society places upon well-to-do Westerners and developed nations. This paper makes use of a thesis by Axel Honneth to the effect that political thinking needs “a basic conceptual shift to the normative premises of a theory of recognition that locates the core of all experiences of injustice in the withdrawal of social recognition, in the phenomena of humiliation and disrespect.” Honneth identifies three spheres of recognition in modern societies: love, law, and achievement. I offer some exposition of his theory and then argue that global justice must be understood to embrace the substantive ethical values that arise in these three spheres as well as the procedural standards of moral rightness that belongs to the second of them. Such an expanded conception of global justice will yield an enriched conception of cosmopolitanism.

Developing the textual turn : tracking the grammar of research case records

During action research projects a great deal of written material is produced. Some of this is data generated about the project, some about the process of the research and some is reflective writing about the researcher(s). In this article I propose that a deliberate focus on the tracking of texts might be helpful in action research, particularly if the inquiry is working within significant constraints. Working with a range of documents and informed by the work of Dorothy Smith on the texting of ruling relations, I show how a multiagency project based in one school slipped away from its original community development goals into a more 'professional service' model. I also show how the project was able to resist partially the requirement by the funding body to use a rational strategic planning model through the production of taped conversations and meta-analytic papers. Although this is a single case, I contend that this example points to the potential utility of an explicit focus on the textual practices of action research.

Advancing architecture ecologies : energy principles in nature and urban systems

The search for a coherent approach to optimising the delivery of sustainable development has moved from rhetoric to reality, shaped by international drivers such as the UN Millennium Development Goal and the UN 'Decade of Education for sustainable development 2005- 2014'. Emphasis has been recently placed by Governmental bodies on creativity and innovation as a way to promote and sustain the social, cultural and economic well-being. This has led to, amongst other things, the development of a series of new initiatives to promote sustainable development. There is still a lack of understanding of the impacts of sustainability on architecture and their associated and interrelated ecologies because, at least in part, there is no significant joined up thinking regarding the implications of sustainability across the whole design, implementation and operation processes. There is a considerable challenge to ensure integration, cross-fertilisation and dissemination to provide meaningful outputs from the vast array of ecological systems with their differing structures. This paper explores the processes rather than products of ecological systems and possibilities for a credible integral system that guide sustainable development and advance architecture ecologies. The paper traces back the roots of the divorce between architecture profession and technology and highlights the importance of reaching back to the true meanings of Techne as key to develop integral sustainable systems. The paper underlines the energy principles that construct ecological principles and provide explanation of how such systems can be interpreted in the built environment. Enriching ecological culture is not a physical development or a large expensive projects but rather in a coherent and focused efforts by a group of professionals, academics, and practitioners with multi disciplinary talents to build a complex and multi facets of integral systems and ideas.

Why use action research for teachers’ professional learning in PNG?

This paper reports on a study of the use of action research for remote primary school teachers’  professional learning in two provinces in PNG. There is significant international literature and research available on the characteristics of professional learning models that lead to quality outcomes for teachers and students alike. Action research is one approach to professional learning that includes a number of these internationally recognised characteristics. It constitutes an inquiry-based approach that encourages teachers to reflect on their own practices, and take ownership of the solutions to problems occurring in their own contexts.

The project draws on the international literature and research on effective professional learning, as well as the particular requirements of teachers in remote areas of Papua New Guinea, to develop a model for professional learning that could be adopted as a sustainable and effective approach to improving student learning outcomes. Improving such outcomes is essential in countries such as Papua New Guinea as they strive to achieve the Millennium Development Goal of Universal Basic Education.

The paper first provides a rationale for using action research in the context of remote schools in Papua New Guinea. A critique follows of the issues associated with the methodology and how these issues were resolved throughout the action research process and, finally, the paper concludes with some suggestions on how this model can be appropriated in other countries’ contexts.

The role of traditional knowledge and access to genetic resources in biodiversity conservation in Southeast Asia

The article examines international treaties linking trade and environment, their governance models and implementation in the context of Southeast Asia. Particular attention is being paid to the role of intellectual property concepts, customary law and traditional knowledge as incentives for biodiversity conservation and to difficulties in defining the subject matter and communities of knowledge holders. Indonesia’s regulation of traditional knowledge and access to biodiversity is discussed as example. The article concludes that national development goals and interests in royalty collection frequently dominate the discussion and that key concepts are still insufficiently defined to avoid overlaps and conflicts. Genuine local support for the conservationist aims of the models will depend on whether a benefit flow to communities can be ensured and their original role to act as incentives can be realised. International collaboration is important to avoid disputes concerning biodiversity related knowledge held across borders.

Old challenges and new opportunities for the MDGs : now and beyond 2015

As we approach the 2015 date by which the Millenium Development Goals (MDGs) are to be achieved, there is increasing scrutiny as to the progress towards their achievement. The MDGs were intended to be global targets and not necessarily to be assessed at the country level. In other words, countries were to contribute to the global targets but not be held to account against them, as they were originally conceived. In practice though, countries are assessed against the global MDG targets. It is appropriate that continuing interest be paid to the achievement of the MDGs, however it is also necessary that the global community now start to turn its attention to what framework for addressing the world's development needs beyond the MDG timeframe following 2015. The ‘poverty landscape’ has changed significantly in the last decade – partly as a result of the international community's focus on the MDGs – and so it is necessary that a new approach to poverty alleviation reflect this changed reality. This paper introduces a range of papers presented at an international conference on the MDGs that critically analyse the current MDGs and pose questions as to how should we follow the MDGs beyond 2015.

Scaling-up foreign aid : will the 'big push' work?

International donors are substantially scaling-up aid programmes. At the same time, there are widespread reservations over how much aid recipient countries can use effectively. Such concerns are supported by the aid effectiveness literature which finds that there are limits to the amounts of aid recipients can efficiently absorb. This article demonstrates that a ‘big push’ in foreign aid will not lead to diminishing returns as long as donors get the inter-country allocation of aid right. This is true even if donors provide aid at levels equal to the well-known target of 0.7 per cent of their gross national income

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.

Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

Human resources development for sustainable aquaculture in the new millennium

Human resources development (HRD) is pivotal to aquaculture development in the new millennium, particularly so in the changing global pressure for all development to be environmentally and socially acceptable, irrespective of the economic status of nations. In the above context, HRD in the aquaculture sector has to have a more holistic approach, and the type of training provided has to be changed accordingly. Most nations in which aquaculture plays a significant role in poverty alleviation recognise that HRD is a key to sustained development of the sector. The types and levels of training required in the sector in the foreseeable future are discussed. The need to increase specialised training, particularly for researchers, in some of the developing nations likely to play adominant role in the aquaculture sector in the ensuing years, is also underlined. Examples are presented to indicate that current development programmes do not cater to HRD to the extent that is desirable to have a long-term impact.

Information systems development contracts : An exploratory study of Australian legal pratitioners' and information systems professionals' perceptions

IS professionals are primarily concerned with the development of a project to meet the goals of a client. Unfortunately, IS professional do not always pay close attention to the contract or to its management and are often unaware of the legal implications of the contracts to which they are assenting. Legal advice can be sought during pre-contractual processes to help ensure that the contract meets the expectations of all the parties. If the project does not meet stakeholder’s expectations, thus causing a contract to come into dispute, lawyers may be called in to review the contract and to seek a settlement. This paper reports an exploratory study of the differences in perceptions of IS development contracts that exist between IS professionals and legal practitioners.

Roles of MFI support of ICTs to aid socio-economic development

Today there is a consensus on the use of Information and Communication Technologies (ICTs) for development and ICTs are widely recognized as vital tools to promote various social goals. These collections of technologies ICTs have also enabled and smoothed an avenue for monumental tran formation in the process of socio-economic development in developing countries. In this paper, we discuss two major areas in the development arena associated with socio-economic development in South Asia, namely, the role of Microfinance in expansion of ICT in the region and its effects on development and poverty alleviatiori. We put forward the argument that through the intervention of microfinance, ICT can both directly and indirectly impact on growth and the way in which the adoption of ICT can be distributed to the poor.

Ecologically sustainable development and architecture: the impact of rating tools

The concept of Ecologically Sustainable Development (ESD) has become an important issue – albeit often scarcely applied – in the design of commercial buildings. To encourage the adoption of sustainable strategies in the practice of design and to address the environmental problems caused by these developments, governments and organisations of various countries have proposed the adoption of scorecard rating tools to inform designers of the impact of their decisions and to present a way of establishing project goals and objectives early in the design process. In Australia, the recent introduction of the Green Star Rating Tool (Office Design) is believed to provide the architects with a ‘whole-of-building’ assessment of the environmental impact of their design by creating a checklist against which to benchmark performance. This paper follows the design of a commercial building, evaluating the impact of Green Star in the overall process. The results of the study suggest the need to include the use of scorecard rating tools in a more integrated model, where ESD is considered at every stage of design and construction rather than being a separate component applied only to promote the ‘greenness’ of a building. Rating tools can be an asset to the design team, provided sustainable requirements are reinforced throughout the entire process.