R4D Kazakhstan

Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for health-care providers

Fri, 11 May 2012 05:02 GMT

Document Type: Journal Article
Creator: Guindon, G.E.; Lavis, J.N.; Boupha, B.; Shi, G.; Sidibe, M.; Turdaliyeva, B.

Production Year: 2010

Citation: Guindon, G.E.; Lavis, J.N.; Boupha, B.; Shi, G.; Sidibe, M.; Turdaliyeva, B. Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for health-care providers. Health Research Policy and Systems (2010) 8 (1) 3. [DOI: 10.1186/1478-4505-8-3]

Summary: Background: The reliability and validity of instruments used to survey health-care providers' views about and experiences with research evidence have seldom been examined. Methods: Country teams from ten low- and middle-income countries (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal and Tanzania) participated in the development, translation, pilot-testing and administration of a questionnaire designed to measure health-care providers’ views and activities related to improving their clinical practice and their awareness of, access to and use of research evidence, as well as changes in their clinical practice that they attribute to particular sources of research evidence that they have used. We use internal consistency as a measure of the questionnaire’s reliability and, whenever possible, we use explanatory factor analyses to assess the degree to which questions that pertain to a single domain actually address common themes. We assess the questionnaire’s face validity and content validity and, to a lesser extent, we also explore its criterion validity. Results: The questionnaire has high internal consistency, with Cronbach's alphas between 0.7 and 0.9 for 16 of 20 domains and sub-domains (identified by factor analyses). Cronbach's alphas are greater than 0.9 for two domains, suggesting some item redundancy. Pre- and post-field work assessments indicate the questionnaire has good face validity and content validity. Our limited assessment of criterion validity shows weak but statistically significant associations between the general influence of research evidence among providers and more specific measures of providers' change in approach to preventing or treating a clinical condition. Conclusion: Our analysis points to a number of strengths of the questionnaire - high internal consistency (reliability) and good face and content validity - but also to areas where it can be shortened without losing important conceptual domains.

Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for researchers

Fri, 11 May 2012 04:30 GMT

Document Type: Journal Article
Creator: Cameron, D.; Lavis, J.N.; Guindon, E.; Akhtar, T.; Posada, F.B.; Ndossi, G.D.; Boupha, B.

Production Year: 2010

Citation: Cameron, D.; Lavis, J.N.; Guindon, E.; Akhtar, T.; Posada, F.B.; Ndossi, G.D.; Boupha, B. Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for researchers. Health Research Policy and Systems (2010) 8 (1) 4. [DOI: 10.1186/1478-4505-8-4]

Summary: Background: A questionnaire could assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. No questionnaire focused on researchers' engagement in bridging activities related to high-priority topics (or the potential correlates of their engagement) has been developed and tested in a range of low- and middle-income countries (LMICs). Methods: Country teams from ten LMICs (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal, and Tanzania) participated in the development and testing of a questionnaire. To assess reliability we calculated the internal consistency of items within each of the ten conceptual domains related to bridging activities (specifically Cronbach’s alpha). To assess face and content validity we convened several teleconferences and a workshop. To assess construct validity we calculated the correlation between scales and counts (i.e., criterion measures) for the three countries that employed both and we calculated the correlation between different but theoretically related (i. e., convergent) measures for all countries. Results: Internal consistency (Cronbach’s alpha) for sets of related items was very high, ranging from 0.89 (0.86- 0.91) to 0.96 (0.95-0.97), suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures (with gammas ranging from 0.36 to 0.73). Assessments using convergent measures also showed significant associations (with gammas ranging from 0.30 to 0.50). Conclusions: While no direct comparison can be made to a comparable questionnaire, our findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.

Diversity of Human Immunodeficiency Virus Type 1 Subtype A and CRF03_AB Protease in Eastern Europe: Selection of the V77I Variant and Its Rapid Spread in Injecting Drug User Populations

Thu, 02 Feb 2012 03:55 GMT

Document Type: Journal Article
Creator: Roudinskii, N.I.; Sukhanova, A.L.; Kazennova, E.V.; Weber, J.N.; Pokrovsky, V.V.; Mikhailovich, V.M.; Bobkov, A.F.

Production Year: 2004

Citation: Roudinskii, N.I.; Sukhanova, A.L.; Kazennova, E.V.; Weber, J.N.; Pokrovsky, V.V.; Mikhailovich, V.M.; Bobkov, A.F. Diversity of Human Immunodeficiency Virus Type 1 Subtype A and CRF03_AB Protease in Eastern Europe: Selection of the V77I Variant and Its Rapid Spread in Injecting Drug User Populations. Journal of Virology (2004) 78 (20) 11276-11287. [DOI: 10.1128/JVI.78.20.11276-11287.2004]

Summary: To characterize polymorphisms of the subtype A protease in the former Soviet Union, proviral DNA samples were obtained, with informed consent, from 119 human immunodeficiency virus type 1 (HIV-1)-positive untreated injecting drug users (IDUs) from 16 regions. All individuals studied have never been treated with antiretroviral drugs. The isolates were defined as IDU-A (n = 115) and CRF03_AB (n = 4) by using gag/env HMA/sequencing. The pro region was analyzed by using sequencing and original HIV-ProteaseChip hybridization technology. The mean of pairwise nucleotide distance between 27 pro sequences (23 IDU-A and 4 CRF03_AB) was low (1.38 ± 0.79; range, 0.00 to 3.23). All sequences contained no primary resistance mutations. However, 13 of 23 (56.5%) subtype A isolates bore the V77I substitution known as the secondary protease mutation. V77I was associated with two synonymous substitutions in triplets 31 and 78, suggesting that all V77I-bearing viruses evolved from a single source in 1997. Hybridization analysis showed that 55 of 115 (47.8%) HIV-1 isolates contained V77I, but this variant was not found in any of 31 DNA samples taken from regions, where the HIV-1 epidemic among IDUs started earlier 1997, as well as in any of four CRF03_AB isolates. The results of analysis of 12 additional samples derived from epidemiologically linked subjects showed that in all four epidemiological clusters the genotype of the donor and the recipients was the same irrespective of the route of transmission. This finding demonstrates the transmission of the V77I mutant variant, which is spreading rapidly within the circulating viral pool in Russia and Kazakhstan. The continued molecular epidemiological and virological monitoring of HIV-1 worldwide thus remains of great importance.

The Development of Civil Society in Central Asia.

Wed, 22 Jul 2009 07:32 GMT

Document Type: Miscellaneous
Creator: J. Giffen, L. Earle and C. Buxton

Production Year: 2006

Citation: 143 pp.

Summary: This book is based upon a series of research studies undertaken by local research institutes, academics and NGOs in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan between 1999 and 2003. The studies had a dual aim: firstly, to deepen understanding of the dynamics of civil society development in these countries, and secondly, to strengthen local institutions’ research capacity in data collection and analysis. Drawing on the findings of these studies and placing them within the wider body of programmatic experience and research undertaken by INTRAC and its local partners since 1994, this book will provide insight into the way in which civil society has developed during the period of Central Asian independence to date. Maintaining a critical stance and acknowledging the complexity of Central Asian realities, it examines how civil society has been shaped, hindered and enriched by internal and external forces, both contemporary and historical. Combining findings from empirical case studies with analysis of relevant literature, this book is both an investigation into the specificities of Central Asian civil societies and a broader examination of the emergence of civil society in ‘transition’ countries.

Health service utilisation in the Former Soviet Union: evidence from eight countries.

Thu, 09 Apr 2009 03:49 GMT

Document Type: Miscellaneous
Creator: Balabanova, D.; McKee, M.; Pomerleau, J.; Rose, R.; Haerpfer, C.

Production Year: 2004

Citation: Health Services Research, 39(6), Part II, 1927-1949, 2004.

Summary: In the past decade, the countries that emerged from the Soviet Union have experienced major changes in the inherited Soviet model of health care, which was centrally planned and provided universal, free access to basic care. The underlying principle of universality remains, but coexists with new funding and delivery systems and growing out-of-pocket payments. The objectives of this study were to examine patterns and determinants of health care utilization, the extent of payment for health care, and the settings in which care is obtained in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine.

Working Paper No. 39. The SCO: a regional organisation in the making.

Fri, 12 Dec 2008 05:22 GMT

Document Type: Miscellaneous
Creator: A. Matveeva and A. Giustozzi

Production Year: 2008

Citation: Crisis States Working Papers Series No.2, No. 39, 32 pp.

Summary: The Shanghai Cooperation Organisation (SCO), which was established in 2001, comprises six Eurasian states (China, Kazakhstan, Kyrgyzstan, Russia, Tajikistan and Uzbekistan) and covers territory hosting a quarter of the world's population. This article examines the rapid growth of the SCO. The study is structured in the following way: it first assesses the recent history of violence and potential for conflict in the region, and then outlines the SCO mandate, balance of power and internal and external dynamics. It discusses the SCO's shared values, and how they facilitate or impede the development of common action. It then proceeds to outline the SCO's main activities in the security sphere and its 'alternative model' of statehood and covers the role of observers and other actors in the region vis-à-vis the SCO. Finally it concludes with reflections on the SCO's effectiveness. Some of our judgements are tentative because the SCO is a new organisation. It might well become a major player in Central Asia and beyond but it could also limp along with little impact if Sino-Russian relations deteriorate.

Impacts of privatisation on range and livestock management in semi-arid Central Asia

Mon, 19 Nov 2007 18:00 GMT

Project Status: Completed
Project Background: In ex-Soviet Central Asia, political change has provoked debate about policy on property rights and the organisation of output/ input markets. How best to use the region's dry rangelands covering about 60% of the five Central Asian Republics is a crucial part of these wider debates. Policy formulation is hampered by unresolved questions about the relative environmental and economic advantages of extensive, mobile versus intensive, irrigation-based livestock production. The research proposed here will address these questions. Senior applied scientists in Central Asia are influential advisors to ministers and cabinets of their national governments. This institutional relationship was established under the Soviet Union and differs from that common in Western European countries, in which scientific conclusions are rarely communicated directly to policy-makers. However, policy formulation on the vast and globally-significant grasslands and deserts of Central Asia is now severely constrained. Local scientific advisors lack contemporary data on the dynamics of livestock and natural resource use, and the effects of these changes on pastoral livelihoods. They also lack appropriate methods for rapidly analysing these changes. To update what is known about the rangeland, using methods adapted for market-based livestock production systems, would greatly improve the relevance of advice given by national scientists to policy-makers in the future. Pastoralists in Central Asia are currently neglected in the drive for market reform. Commercial attention is focussed on the mineral and industrial sectors, while agricultural development is concentrated on the irrigated and rainfed croplands. Pastoralists have lost many of their productive assets, namely livestock, are isolated geographically from social services and lack access to and knowledge of new market opportunities. They are particularly vulnerable to the economic changes taking place, since few have skills suitable for urban employment, they are no longer buffered by government support programmes, and they must cope with an environment characterised by low productivity, low return on investment, and high climatic risk. The relative and absolute decline in the output of livestock from rangelands has relegated this sector to a low national priority, while international donors are mainly concerned with environmental degradation on rangelands rather than with pastoral welfare (eg: ADB 1996; World Bank 1997). The rangelands still have the potential to provide livelihoods to millions of people whose contribution to national income could also be raised under better-informed policies.

Project Objectives: To research two issues leading to poverty among pastoralists in Central Asia and in neighbouring regions: (a) loss by livestock producers of effective use of the rangelands. (b) loss of access by pastoralists to secure markets for their products.

To provide policy guidelines for improved management of semi-arid rangeland and extensive livestock production systems under new market and institutional conditions in Central Asia and neighbouring Asian Regions.

Intended Outputs: Information for better natural resource management.

Analysis of livestock feeding systems; livestock economy at household and wider scales. Research institutional building.

Policy recommendations for improving range management, livestock production and marketing, and property rights institutions.

First year results peer-reviewed at workshop in Nov 1998.

Workshop results disseminated to national policy-makers, donors, NGOs and international scholars, early 1999.

International Research Placements for MSc Students

Mon, 19 Nov 2007 18:00 GMT

Project Status: Completed
Project Background: MSc students on courses in Irrigation Engineering and Engineering for Development at the Institute of Irrigation and Development Studies (IIDS) follow taught courses in technical, social and economic subjects relevant to overseas development for nine months of the one-year course. The final three months are devoted to a research project which leads to a written dissertation. It is of great benefit to the students through the experience gained and to IIDS through the overseas work, experience and contacts, if this research can be carried out on existing projects in developing countries. Students from the United Kingdom and Europe are therefore placed on such projects with consulting engineering firms, commercial enterprises, research institutions and non-governmental organisations, to carry out field research which is directly related to the ongoing work. This proposal seeks funding to facilitate these overseas placements.

Project Objectives: The research will be carried out by MSc students in irrigation engineering and engineering for development.

Improve understanding of technical and social issues related to both rural water supplies and irrigation.

Intended Outputs: Literature reviews and guided field research studies leading to analysis of research findings and reporting in the form of MSc dissertations. Publication of papers on some original topics.

Privatisation/transfer of irrigation management - Central Asia

Mon, 19 Nov 2007 18:00 GMT

Project Status: Completed
Project Background: The five Republics of Central Asia, as elsewhere in the former Soviet Union, have suffered considerable economic hardship following independence. Except in the Kyrgyz Republic and Uzbekistan, in 1999 GNP was lower than 10 years earlier (by over 10% in Tajikistan). Despite a 2.3% increase in GNP in the Kyrgyz Republic, GNP per head remains at US$300. Only in Kazakhstan is GNP/head above US$ 1,000.

In this situation, Governments cannot afford to keep the often-sophisticated irrigation systems operable and are transferring ownership, together with responsibility for operation and maintenance, to users and to quasi-private sector organisations.

At the same time, there is considerable other social change, including division, distribution and privatisation of farms whilst social services are strained by the ongoing transition. As large farming units are broken up, major modifications to the canal systems are required. In many areas, the rural population is ill-prepared for the changes; in the irrigation sector, for example, former farm operatives are having to learn both irrigation system and farm management. Considerable investment is required to keep the ageing irrigation systems operable. Without effective transfer of irrigation system management, investment in rehabilitation will fail to deliver reliable, sustainable water supplies - on which the vast majority of the 32.5 million rural population depend.

To date, the largely project-based approach to irrigation management transfer (IMT) has treated the rural populations as 'guinea pigs' in the search for a model for successful turnover. Such initiatives frequently include support to the newly established small farms in establishing water management organisations such as Water User Associations and Federations and institutional support to Government to create a suitable institutional framework. Governments and local institutions have been helped in this IMT by several donors, usually operating independently. The World Bank, Asian Development Bank and USAID are all involved in significant IMT projects, whilst NGOs and organisations such as Tacis have separately been obtaining valuable experience in more discrete assistance exercises.

Despite appreciable effort and financial support, there has been mixed success in such transfer of irrigation system management. Failed 'experiments' not only represent a waste of investment, but also set back the process of transfer to private management. This leaves communities dependent on limited Government funding, and fails to capitalise of the full potential human resources that could be available to keep the irrigation systems functioning. The rural poor can be left more vulnerable than before the 'experiment' took place.

After nearly a decade of change, there is a wealth of information potentially available for Governments, donors, local and foreign specialists to tap into and to help avoid the pitfalls of earlier transfer programmes. However this information is largely held either at project level or with individual development professionals. There is little easily accessible within the public domain.

Bringing together and disseminating this information, as guidelines, would give confidence to Governments and local institutes that their projects were building on best practice and were not part of continued experimentation. It would meet a specific need perceived by both foreign development professionals and government institutes as demonstrated by the support set out in Annex 3.3, and through this, reduce the vulnerability of rural communities' to inappropriate project design.

Although the research is aimed at the five Republics, it is anticipated that this will concentrate on generic lessons and thus will be applicable elsewhere. Indeed, for this reason the research's success is not contingent on obtaining good co-operation from Governments in all countries.

Project Objectives: To raise awareness of best practice in applying appropriate institutional and operational changes to achieve irrigation management transfer, learning from regional experience in Central Asia.

Intended Outputs: Better awareness of the successes and pitfalls in adopting irrigation management transfer to improve irrigation system functionality.

The Extent and Nature of Absolute Poverty

Mon, 19 Nov 2007 18:00 GMT

Project Status: Current
Project Background: To produce cost-effective and efficient ways of eradicating poverty, it must be defined and measured accurately. Social science research shows that, whilst all cultures have a concept and definition of poverty, these often vary. Until the World Summit on Social Development in Copenhagen there was no agreed definition. However, the 1995 Copenhagen Declaration and Programme of Action included the preparation of national anti-poverty plans based on measures in all countries of 'absolute' and 'overall' poverty. 'Absolute' poverty is defined as ,a condition characterised by severe deprivation of basic human needs, including food, safe drinking water, sanitation facilities, health, shelter, education and information. It depends not only on income but also on access to social services.,

Project Objectives: This research will provide reliable scientific estimates of the extent and nature of absolute poverty in the world, based on the definition agreed to by the government of 117 countries at the 1995 World Summit on Social Development and within the framework of International Human Rights Conventions.

Intended Outputs: This research will provide reliable and valid scientific measurements of the extent and nature of absolute poverty of adults and children, by operationalising the internationally agreed definition. Without good comparable measures of poverty, it will be impossible to determine if any anti-poverty policies are working effectively and efficiently.