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.

Desired learning outcomes for the curricula in financial services industry as perceived by professionals in the financial services industry located in the Greater Toronto Area /

This study sought to explore the changing nature of the financial services industry in Toronto, Canada and the impact that these changes will have on the vocational educational outcomes required by Ontario Colleges of Applied Arts and Technology (CAAT) graduates who wish to enter the financial services industry. The study was descriptive and exploratory, based on both quantitative and qualitative data. Triangulation of 3 data sources (a collection of newspaper articles from the Toronto Star between July 1999 and June 2000, the calendars of the 25 CAATs, and a survey questionnaire prepared by me and distributed to subject matter experts who are key practitioners in the financial services industry) was used. The study contains a discussion of how the financial services industry is changing. The first question to be answered was: What do current practitioners in financial services perceive to be the knowledge, skills, and attitudes that will be required of future graduates for employment within the financial services industry? The study found that Ontario CAAT's graduates entering the financial services field need both business and financial services vocational learning outcomes. Colleges should have 2 programs 1 in accounting and 1 in financial services. The report addresses which specific topics should be included in the financial services program. The second question to be answered was: How does this anticipated profile of knowledge, skills, and attitudes change depending on the degree of implementation of the new technologies by the survey respondent? The study found no pattern. The third question to be answered was: In what way do existing programs need to change in the area of accreditation as perceived by the respondents? The study found that for accreditation, 3 credentials should be addressed within the financial services program. These are the Canadian Securities, the Life Underwriters, and the Certified Financial Planner designations. The last question to be answered was: What new knowledge, skills, and attitudes need to be incorporated into college curricula to address changing needs in the employment sector? For each Ontario CAAT which has a financial services program (excluding accounting), their program was reviewed in light of the topics as perceived by professionals in the financial services industry.

Is microfinance an ethical way to provide financial services to the poor?

Microfinance is increasingly seen as a major development tool. Its promise to help the poor by providing financial services is seen as the major reason for its support. Nevertheless, its ability to effectively reduce poverty is not yet clear, and it generates some unresolved ethical questions. These become even more prominent in the process of commercialization. The impact on poverty is usually measured in financial terms. In this paper, poverty is defined in a broader sense to include deficiency in human and social capital. The article shows that, in this broad sense, microfinance may have negative as well as positive effects on poverty.

Return and Volatility performance comparison of Ethical and Non-ethical publicly-listed financial services companies

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Understanding Recreational Services of Urban Riverfront Space for Planning Purposes

In the process of urbanization, natural and semi-natural landscapes are increasingly cherished as open space and recreational resource. Urban rivers are part of this kind of resource and thus play an important role in managing urban resilience and health. Employing the example of Tianjin, this doctoral dissertation research aims at learning to understand how to plan and design for the interface zones between urban water courses and for the land areas adjacent to such water courses. This research also aims at learning how to link waterfront space with other urban space in order to make a recreational space system for the benefit of people. Five questions of this dissertation are: 1) what is the role of rivers in spatial and open space planning? 2) What are the human needs regarding outdoor open space? 3) How do river and water front spatial structures affect people's recreational activities? 4) How to define the recreational service of urban river and waterfront open space? 5) How might answering these question change planning and design of urban open space? Quantitative and qualitative empirical approaches were combined in this study for which literature review and theoretical explorations provide the basis. Empirical investigations were conducted in the city of Tianjin. The quantitative approach includes conducting 267 quantitative interviews, and the qualitative approach includes carrying out field observations and mappings. GIS served to support analysis and visualization of empirical information that was generated through this study. By responding to the five research questions, findings and lessons include the following: 1) In the course of time rivers have gained importance in all levels and scales of spatial planning and decision making. Regarding the development of ecological networks, mainly at national scale, rivers are considered significant linear elements. Regarding regional and comprehensive development, river basins and watersheds are often considered as the structural link for strategic ecological, economic, social and recreational planning. For purposes of urban planning, particularly regarding recreational services in cities, the distribution of urban open spaces often follows the structure of river systems. 2) For the purpose of classifying human recreational needs that relate to outdoor open space Maslow's hierarchy of human needs serves as theoretical basis. The classes include geographical, safety, physiological, social and aesthetic need. These classes serve as references while analyzing river and waterfront open space and other kinds of open space. 3) Regarding the question how river and waterfront spatial structures might affect people's recreational activities, eight different landscape units were identified and compared in the case study area. Considering the thermal conditions of Tianjin, one of these landscape units was identified as affording the optimal spatial arrangement which mostly meets recreational needs. The size and the shape of open space, and the plants present in an open space have been observed as being most relevant regarding recreational activities. 4) Regarding the recreational service of urban river and waterfront open space the results of this research suggest that the recreational service is felt less intensively as the distances between water 183 front and open space user’s places of residence are increasing. As a method for estimating this ‘Service Distance Effect’ the following formula may be used: Y = a*ebx. In this equation Y means the ‘Service Distance’ between homes and open space, and X means the percentage of the people who live within this service distance. Coefficient "a" represents the distance of the residential area nearest to the water front. The coefficient "b" is a comprehensive capability index that refers to the size of the available and suitable recreational area. 5) Answers found to the questions above have implications for the planning and design of urban open space. The results from the quantitative study of recreational services of waterfront open space were applied to the assessment of river-based open space systems. It is recommended that such assessments might be done employing the network analysis function available with any GIS. In addition, several practical planning and designing suggestions are made that would help remedy any insufficient base for satisfying recreational needs. The understanding of recreational need is considered helpful for the proposing planning and designing ideas and for the changing of urban landscapes. In the course of time Tianjin's urban water system has shrunk considerably. At the same time rivers and water courses have shaped Tianjin's urban structure in noticeable ways. In the process of urbanization water has become increasingly important to the citizens and their everyday recreations. Much needs to be changed in order to improve recreational opportunities and to better provide for a livable city, most importantly when considering the increasing number of old people. Suggestions made that are based on results of this study, might be implemented in Tianjin. They are 1) to promote the quality of the waterfront open space and to make all linear waterfront area accessible recreational spaces. Then, 2), it is advisable to advocate the concept of green streets and to combine green streets with river open space in order to form an everyday recreational network. And 3) any sound urban everyday recreational service made cannot rely on only urban rivers; the whole urban structure needs to be improved, including adding small open space and optimize the form of urban communities, finally producing a multi-functional urban recreational network.

Factors affecting choice of financial services among rural consumers: Emerging experiences from Gicumbi District, northern Province in Rwanda

Enhancement of financial inclusivity of rural communities is often recognised as a key strategy for achieving economic development in third world countries. The main objective of this study was to examine the factors that influence consumers’ choice of a rural bank in Gicumbi district of Rwanda. Data was collected using structured questionnaires and analysed using a binary probit regression model and non-parametric procedures. Most consumers were aware of Popular Bank of Rwanda (BPR) and Umurenge SACCO through radio advertisements, social networks and community meetings. Accessibility, interest rates and quality of services influenced choice of a given financial intermediary. Moreover, the decision to open a rural bank account was significantly influenced by education and farm size (p<0.1). These results indicate the need for financial managers to consider these findings for successful marketing campaigns.

Livelihood diversification and moneylending in a Rajasthan village: what lessons for rural financial services?

The complexity of rural economies in developing countries is increasingly recognised, as is the need to tailor poverty reduction policies according to the diversity of rural households and their requirements. By reference to a village in Western India, the paper examines the results of a longitudinal micro-level research approach, employed for the study of livelihood diversification and use of informal finance. Over a 25-year period, livelihoods are shown to have become more complex, in terms of location, types of non-farm activities, and combinations of activities. Moreover, livelihood pathways taken continue to be critically affected by economic and social inequalities implicit in the caste system and tribal economy. A longitudinal micro-level research approach is shown to be one that can effectively identify the many complexities of rural livelihoods and the continued dependence on the informal financial sector, providing important insights into the requirements for rural financial products and services.

Attitudes of rural branch managers in Madhya Pradesh, India, toward their role as providers of financial services to the poor

Discussions on banking reforms to reduce financial exclusion have referred little to possible attitudinal constraints, on the part of staff at both branch and institutional levels, inhibiting the provision of financial services to the poor. The research project, funded by the ESCOR (now Social Science Research) Small Grants Committee, has focused on this aspect of financial exclusion. The research commenced in May 2001 and was completed in April 2002. Profiles of the rural bank branch managers, including personal background, professional background and workplace, are presented. Attitudes of managers toward aspects of their work environment and the rural poor are examined, using results from both quantitative and qualitative analysis. Finally, the emerging policy implications are discussed. These include bank reforms to address human resource management, the work environment, intermediate bank management and organization, and the client interface.