Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Ministério da Saúde do Governo do Ruanda identifica a saúde mental como uma área de prioridade estratégica para a intervenção em resposta à alta carga dos transtornos mentais no Ruanda. Ao longo dos últimos 20 anos após o genocídio, o sector público reconstruiu sua Resposta Nacional de Saúde Mental com base no acesso equitativo aos cuidados, através do desenvolvimento de uma Política Nacional de Saúde Mental e novas estruturas de saúde mental. A política de Saúde Mental do Ruanda, revista em 2010, prima pela descentralização e integração dos serviços de saúde mental em todas as estruturas nacionais do sistema de saúde e ao nível da comunidade. O presente estudo de caso tem como objetivo avaliar a situação do sistema de saúde mental de um distrito típico de uma área rural no Ruanda, e sugerir melhorias, incluindo algumas estratégias para monitoras as mudanças. Os resultados do estudo permitirão ao Ruanda reforçar a sua capacidade para implementar o Plano Nacional de Saúde Mental ao nível dos distritos. O relatório também será útil para monitorar o progresso da implementação de serviços de saúde mental nos distritos, incluindo a prestação de serviços de base comunitária e a participação dos usuários, suas famílias e outros interessados na promoção, prevenção, assistência e reabilitação em saúde mental. Este estudo também procurou avaliar o progresso da implementação dos cuidados de saúde mental a nível descentralizado, com vista a compreender as implicações em termos de recursos desses processos. Foi realizada uma análise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas responsáveis, usando o Instrumento de Avaliação de Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Os resultados sugerem que os recursos humanos para a saúde mental e serviços de base comunitária de saúde mental no distrito continuam a ser extremamente limitados. Os profissionais de saúde mental são adicionalmente limitados na sua capacidade para oferecer intervenções de emergência a pacientes psiquiátricos e garantir a continuidade do tratamento farmacológico a pacientes com condições crônicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de saúde mental deve envolver também os representantes das famílias e dos usuários no processo de planificação de modo a melhorar a sua contribuição no processo de implementação das atividades de saúde mental. Este estudo de caso do Distrito de Bugesera oferece a primeira análise de nível distrital dos serviços de saúde mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de saúde mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de saúde mental a este nível, aumentando o financiamento para a implementação de serviços clínicos de saúde mental e os recursos humanos disponíveis para a prestação de cuidados de saúde mental, principalmente a nível dos cuidados primários.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Marketing of Library Services in an Academic Environment

Marketing of information services is now an important goal of librarians all over the ~orld t? attract mor~ users to the libr~ry. thereby promoting user satisfaction. Marketing IS considered ~s ~n Integr~1 part of libraries and information centres mainly due to the developments In information t.echnology, information explosion, and declining library budgets. Kotler defines marketing as the "analysis, planning, implementation and control o~ carefully formulated programs designed to bring about voluntary exchanges of values WIth target markets fo~ the ~~rpos~ of~chievingorganizational objectives". Organizations suc.h as museums, unrversittes, libraries, and charities need to market their causes and their products to gain. political and social support as well as economic support (Kotler, 1995). In the marketing world people are now migrating from the traditional Four P ~lodelto th~ S~VE mode! (Alt~ns~n, 2013). According to the SAVE model, marketing III an orgarusanon must grve pnonty to 'Solutions' instead of the features or functions of~he.'Product" Similarily it is to focus on 'Access', instead of ,Place'; 'Value' instead of Price" so that the benefits are more stressed, rather than production costs. Instead of :Proliloti.on', marketi~g has. to conc~ntrate on 'Educating' the customers, providing lJlfo~mahol~ about t~eJr specific req~lrements, instead of relying on advertising, public rel~tlons, direct selling etc. From a library point ofview, to ensure maximum utilization of library ~ervices there is an increasing need for definite marketing plans to exploit the techn.ologlcal dcvelop",len~s so ~s to entice the users. By anticipating their changing needs and ~y co.mmulllcatl~g WIth them it should be possible to devise strategies to present various library services and products in a perceptive style.

Europe’s New Post-Trade Infrastructure Rules. ECMI Policy Brief No. 20, 8 November 2012

After more than a decade of indecision, the EU is finally now set to implement a consistent regulatory architecture for clearing and settlement. Following the agreement on a European market infrastructure Regulation (EMIR), the European Commission has proposed harmonised rules for centralised settlement depositaries (CSDs), while the European Central Bank is moving forward with its plans for a central eurozone settlement engine. This paper analyses three components of the new post-trade infrastructure measures: 1) the regulatory framework for and supervision of central counterparties under the new EMIR legislation, 2) the authorisation requirements of trade repositories and 3) the draft CSD Regulation and the progress with the ECB’s Target 2 Securities project. It then discusses the impact of the new rules, and argues that, analogous to the unexpected impact of MiFID on trading infrastructures, a similar EMIR revolution may be on its way.

Livestock services and the poor

This paper reviews the economic framework for the delivery of livestock services to the poor. It is argued that the demand for livestock products is likely to increase rapidly and the ability of the poor to participate in the opportunities presented by this growth is linked critically to the availability of good service support, both on the input and output side. Governments therefore have a responsibility to supply the necessary public goods (including the institutions and legal frameworks), and the market infrastructure for facilitating the emergence of efficient markets for livestock services. The paper further argues that the dynamics of public policy in developing countries are much more complex than the simple application of economic logic. It is the larger political economy that often dictates policy choices. It is therefore important to integrate political economy and governance issues into the economic debate on livestock service delivery. The paper also reviews the context in which the markets for livestock services will need to function. Different countries are facing very different sets of issues, and the identification of possible interventions in livestock service markets would require careful field research and analysis. In this context, the paper suggests the elements of a research agenda for the next few years.

Establishing a reliable Jini infrastructure for parallel applications

Java is becoming an increasingly popular language for developing distributed and parallel scientific and engineering applications. Jini is a Java-based infrastructure developed by Sun that can allegedly provide all the services necessary to support distributed applications. It is the aim of this paper to explore and investigate the services and properties that Jini actually provides and match these against the needs of high performance distributed and parallel applications written in Java. The motivation for this work is the need to develop a distributed infrastructure to support an MPI-like interface to Java known as MPJ. In the first part of the paper we discuss the needs of MPJ, the parallel environment that we wish to support. In particular we look at aspects such as reliability and ease of use. We then move on to sketch out the Jini architecture and review the components and services that Jini provides. In the third part of the paper we critically explore a Jini infrastructure that could be used to support MPJ. Here we are particularly concerned with Jini's ability to support reliably a cocoon of MPJ processes executing in a heterogeneous envirnoment. In the final part of the paper we summarise our findings and report on future work being undertaken on Jini and MPJ.

Green infrastructure and ecosystem services - is the devil in the detail?

Background - Green infrastructure is a strategic network of green spaces designed to deliver ecosystem services to human communities. Green infrastructure is a convenient concept for urban policy makers, but the term is used too-generically and with limited understanding of the relative values or benefits of different types of green space and how these complement one another. At a finer scale/more practical level– little consideration is given to the composition of the plant-communities, yet this is what ultimately defines extent of service provision. This paper calls for greater attention to be paid to urban plantings with respect to ecosystem service delivery and for plant science to engage more-fully in identifying those plants that promote various services. Scope - Many urban plantings are designed based on aesthetics alone, with limited thought on how plant choice/composition provides other ecosystem services. Research is beginning to demonstrate, however, that landscape plants provide a range of important services, such as helping mitigate floods and alleviating heat islands, but that not all species are equally effective. The paper reviews a number of important services and demonstrates how genotype choice radically affects service delivery. Conclusions – Although research is in its infancy, data is being generated that relates plant traits to specific services; thereby helping identify genotypes that optimise service delivery. The urban environment, however, will become exceedingly bland if future planting is simply restricted to monocultures of a few ‘functional’ genotypes. Therefore, further information is required on how to design plant communities where the plants identified:- a/ provide more than a single benefit (multi-functionality) b/ complement each other in maximising the range of benefits that can be delivered in one location and c/ continue to maintain public acceptance through diversity. The identification/development of functional landscape plants is an exciting and potentially high impact arena for plant science.

Transparent Fault Tolerance for Web Services based Architectures

Service-based architectures enable the development of new classes of Grid and distributed applications. One of the main capabilities provided by such systems is the dynamic and flexible integration of services, according to which services are allowed to be a part of more than one distributed system and simultaneously serve different applications. This increased flexibility in system composition makes it difficult to address classical distributed system issues such as fault-tolerance. While it is relatively easy to make an individual service fault-tolerant, improving fault-tolerance of services collaborating in multiple application scenarios is a challenging task. In this paper, we look at the issue of developing fault-tolerant service-based distributed systems, and propose an infrastructure to implement fault tolerance capabilities transparent to services.

Chained Negotiation for Distributed Notification Services

Distributed notification services allow consumers and publishers of notifications to interact with different notification services. However, such a distributed infrastructure makes it difficult to share notifications between consumers when consumers are allowed to specify Quality of Service levels. In this paper, we present a chained negotiation engine, enabling distributed notification services to support negotiation and to reuse existing subscriptions. We demonstrate the benefit to the system as a whole by reducing load on service providers and enabling content to be shared.

Trade in services in Latin America and the Caribbean: an analysis of recent trends

Includes bibliography

Brazil's emergence at the regional export leader in services: a case specialization in business services

Includes Bibliography

Séminaire sur la régulation des services d'infrastructure "eau et électricité"

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Modernization and new services of the Brazilian active control network

The Brazilian Network for Continuous Monitoring of GNSS - RBMC is a national network of continuously operating reference GNSS stations. Since its establishment in December of 1996, it has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country. In order to provide better services for RBMC, the Brazilian Institute of Geography and Statistics - IBGE and the National Institute of Colonization and Land Reform - INCRA are both partners involved in the National Geospatial Framework Project - PIGN. This paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. These steps involve the installation of new equipment, provide real time data from a group of core stations and compute real-time DGPS corrections, based on CDGPS (The real-time Canada-Wide DGPS Service) (The Real-Time Canada-Wide DGPS Service. http://www.cdgps.com/ 2009a). In addition to this, a post-mission Precise Point Positioning (PPP) service has been established based on the current Geodetic Survey Division of NRCan (CSRS-PPP) service. This service is operational since April 2009 and is in large use in the country. All activities mentioned before are based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project. This infrastructure of 66 GNSS stations, the real time, post processing services and the potentiality of providing Wide Area DGPS corrections in the future show that the RBMC system is comparable to those available in USA and Europe. © Springer-Verlag Berlin Heidelberg 2012.

Making infrastructure reform in Latin America work for the poor

Includes bibliography