B.J. Regeer

Six guiding principles for evaluating mode-2 strategies for sustainable development

A new generation of public programs emerges, which specifically addresses complex societal problems we witness today. Programs for these types of complex issues—in this article, we consider more closely the challenge of sustainable development—are characterized by emergent design, learning processes between diverse actors, and adaptive management. Managers of these kinds of programs have new demands for evaluation and evaluators. This article describes prevailing evaluation methods for sustainable development (progress assessment, goal-oriented program evaluation, and program theory evaluation) and the challenges they meet when confronted with the complexity of designing and conducting systemic intervention programs for sustainable development. The evaluation framework that we propose offers guiding principles to assist evaluators in evaluating complex programs.

TransFormers in knowledge production: building science–practice collaborations

This article places action learning in the context of system innovation, as it studies the potential use of action learning for system change. In order to effect such system change, collaboration between actors from different institutional backgrounds is essential. To gain insight into if and how action learning can be applied for system change, we study three system change projects in Dutch agriculture. We focus specifically on the approaches developed by the project leaders for collaboration between the scientists and the entrepreneurs and analyse how the interaction between these two contributed to the learning process within the project. This article concludes with guiding concepts for action learning for system change in the field of sustainable development of agriculture and beyond.

Baseline assessment of WHO's target for both availability and affordability of essential medicines to treat non-communicable diseases

Background WHO has set a voluntary target of 80% availability of affordable essential medicines, including generics, to treat major non-communicable diseases (NCDs), in the public and private sectors of countries by 2025. We undertook a secondary analysis of data from 30 surveys in low- and middle-income countries, conducted from 2008–2015 using the World Health Organization (WHO)/Health Action International (HAI) medicine availability and price survey methodology, to establish a baseline for this target. Methods Data for 49 medicines (lowest priced generics and originator brands) to treat cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and central nervous system (CNS) conditions were analysed to determine their availability in healthcare facilities and pharmacies, their affordability for those on low incomes (based on median patient prices of each medicine), and the percentage of medicines that were both available and affordable. Affordability was expressed as the number of days’ wages of the lowest-paid unskilled government worker needed to purchase 30 days’ supply using standard treatment regimens. Paying more than 1 days’ wages was considered unaffordable. Findings In low-income countries, 15.2% and 18.9% of lowest-priced generics met WHO’s target in the public and private sectors, respectively, and 2.6% and 5.2% of originator brands. In lower-middle income countries, 23.8% and 23.2% of lowest priced generics, and 0.8% and 1.4% of originator brands, met the target in the public and private sectors, respectively. In upper-middle income countries, the situation was better for generics but still suboptimal as 36.0% and 39.4% met the target in public and private sectors, respectively. For originator brands in upper-middle income countries, none reached the target in the public sector and 13.7% in the private sector. Across the therapeutic groups for lowest priced generics, CVD medicines in low-income countries (11.9%), and CNS medicines in lower-middle (10.2%) and upper-middle income countries (33.3%), were least available and affordable in the public sector. In the private sector for lowest priced generics, CNS medicines were least available and affordable in all three country income groups (11.4%, 5.8% and 29.3% in low-, lower-middle and upper-middle income countries respectively). Interpretation This data, which can act as a baseline for the WHO target, shows low availability and/or poor affordability is resulting in few essential NCD medicines meeting the target in low- and middle-income countries. In the era of Sustainable Development Goals, and as countries work to achieve Universal Health Coverage, increased commitments are needed by governments to improve the situation through the development of evidence-informed, nationally-contextualised interventions, with regular monitoring of NCD medicine availability, patient prices and affordability.

Exploring ways to reconcile accountability and learning in the evaluation of niche experiments

While evaluation is seen as a mechanism for both accountability and learning, it is not self-evident that the evaluation of niche experiments focuses on both accountability and learning at the same time. Tensions exist between the accountability-oriented needs of funders and the learning needs of managers of niche experiments. This article explores the differences in needs and expectations of funders and managers in terms of upwards, downwards and internal accountability. The article shows that as the multi-stakeholder contexts in which niche experiments take place give rise to various requirements, tensions in evaluation are essentially a specific manifestation of tensions between niche experiments and their multiple contexts. Based on our findings, an adjusted accountability framework is proposed, including several strategies that can reconcile a learning approach with accountability needs in niche experiments aiming to change current practices in a more sustainable direction.

Functional Impairments and Work-Related Outcomes in Breast Cancer Survivors: A Systematic Review

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees’ levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000–March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors.

Unravelling the dynamics of adopting novel technologies: an account of how the closed greenhouse opened-up

Realising broad adoption of complex novel technologies is an important innovation challenge. This paper identifies four notions on the dynamics of adoption of complex novel technologies and two main challenges that hinder adoption. These insights derive from studying literature and analysing the implementation history of the first eight growers that adopted the novel system innovation closed greenhouse. The analysis of these eight histories shows that variety exists in how users value an innovation and that adopters reconstruct the innovation, which creates high levels of uncertainty about the functioning of the system innovation. To stimulate the adoption of novel system innovations and to keep initial values in-scripted, we suggest innovation policy makers to further shelter the system innovation until the stage of take-off.

Comparing patients’ perspectives of “good care” in Dutch outpatient psychiatric services with academic perspectives of patient-centred care

Abstract Background: Over the past six decades, the concept of patient-centred care (PCC) has been discussed in health research, policy and practice. However, research on PCC from a patients’ perspective is sparse and particularly absent in outpatient psychiatric services. Aim: to gain insight into what patients with bipolar disorder and ADHD consider “good care” and what this implies for the conceptualisation of PCC. Method: A literature review on the different conceptualisations of PCC was complemented with qualitative explorative research on the experiences and needs of adults with ADHD and with bipolar disorder with mental healthcare in the Netherlands using focus group discussions and interviews. Results: The elements addressed in literature are clustered into four dimensions: “patient”, “health professional”, “patient–professional interaction” and “healthcare organisation”. What is considered “good care” by patients coincided with the four dimensions of PCC found in literature and provided refinement of, and preferred emphasis within, the dimensions of PCC. Conclusions: This study shows the value of including patients’ perspectives in the conceptualisation of PCC, adding elements, such as “professionals listen without judgment”, “professionals (re)act on the fluctuating course of the disorder and changing needs of patients” and “patients are seen as persons with positive sides and strengths”.

Prices and availability of locally produced and imported medicines in Ethiopia and Tanzania

BackgroundTo assess the effect of policies supporting local medicine production to improve access to medicines.MethodsWe adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR).ResultsThe Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively.The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively.ConclusionsOur results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.

Adoption of Novelties in a Pluralist Society: Exploring an Agropark Case Study

Abstract Implementation efforts of novelties such as new land use facilities frequently involve controversy; even when adoption is expected to result in a more sustainable practice. This article analyses the overlaps of the discursive spheres of the project participants and the stakeholder groups of a proposed novel farm. This will shed light on the work involved when governing for the adoption of novelties. The analysis reveals that reframing and redesigning of the novelty are needed for social embedding. Through functional and conceptual alignment activities, the proposed novelty is aligned more to the perceptions and needs of diverse stakeholder groups.

The Impact of a Rights-Based Counselling Intervention to Reduce Stigma in People Affected by Leprosy in Indonesia

Background This paper assesses the impact of a counselling intervention on reducing leprosy-related stigma in Cirebon District, Indonesia. The unique features of this intervention are its rights-based approach, the underlying Cognitive Behavioural Therapy (CBT) model, the three types of counselling and the lay and peer counsellors who were involved. Methodology/principal findings Mixed methods (e.g. three scales, interviews, focus group discussions and reflection notes) were used to assess the impact of the intervention, which ran over a two-year period. There was a control area with no interventions. The study participants were people affected by leprosy and other key persons (e.g. family members). The sample size differs per method, for example, data regarding 67 counselling clients and 57 controls from a cohort, and notes from 207 counselling clients were examined. The notes showed that most clients faced stigma on a daily basis, whether internalized, anticipated and/or enacted. A significant reduction was found between the before and after total scores of the SARI Stigma Scale (p-value < 0.001), Participation Scale Short (p-value < 0.001) and WHO Quality of Life score (p-value < 0.001) among the counselling clients. While there is also an effect in the control group, it is much larger in the intervention group. Qualitative data indicates that knowledge and rights trigger change. Clients took steps to improve their life such as re-connecting with neighbours, helping in household activities and applying for jobs. Challenges include the wish to conceal their condition. Conclusion/significance The findings show that the counselling intervention was effective in reducing stigma, promoting the rights of people with leprosy and facilitating their social participation. More research is needed on how to create a more sustainable intervention, preferably structurally embedded in the health or social services.