Claire Blanchard

Using baseline and formative evaluation data to inform the Uganda Helmet Vaccine Initiative

Motorcycles are an important form of transportation in Uganda, and are involved in more road traffic injuries than any other vehicle. The majority of motorcycles in Uganda are used as motorcycle taxis, better known locally as boda bodas. Research shows that a motorcycle helmet is effective at reducing a rider’s risk of death and head injury. As part of the Uganda Helmet Vaccine Initiative (UHVI), researchers collected baseline and formative evaluation data on boda boda operators’ helmet attitudes, beliefs, and behaviors to inform UHVI activities. Researchers collected data on motorcycle helmet-related attitudes and beliefs through focus group discussions and structured roadside interviews, and researchers conducted roadside observations to collect data on helmet-wearing behaviors. Of the 12,189 motorcycle operators and passengers observed during roadside observations, 30.8% of drivers and <1% of passengers were wearing helmets. The most commonly reported helmet-wearing barriers from the focus group discussions and structured roadside interviews were: (1) ‘Helmet is uncomfortable’, (2) ‘Helmet is too hot’, (3) ‘Helmet is too expensive’, and (4) ‘Helmet is of low quality’. Researchers incorporated findings from the formative research into the UHVI campaign to increase motorcycle helmet use. Radio messages addressing helmet comfort and cost were widely aired throughout Kampala, Uganda. In addition, campaign staff held nine boda boda operator workshops, covering approximately 900 operators, in which the facilitator addressed barriers and facilitators to helmet use. Each workshop participant received a high-quality tropical motorcycle helmet. UHVI will continue to use a data-driven approach to future campaign activities.

Global Advocacy for Physical Activity (GAPA): global leadership towards a raised profile

Physical inactivity has been recognised by the World Health Organization as one of the leading causes of death due to non-communicable disease (NCD), worldwide. The benefits of action over inactivity can cut across health, environment, transportation, sport, culture and the economy. Despite the evidence, the policies and strategies to increase population-wide participation in physical activity receive insufficient priority from across high, middle and low-income countries; where physical inactivity is a rapidly-emerging issue. There is an increased need for all countries to invest in policies, strategies and supportive environments that inform, motivate and support individuals and communities to be active in ways that are safe, accessible and enjoyable. This commentary presents some recent efforts towards physical activity promotion globally, led by the Global Advocacy for Physical Activity (GAPA). It provides an overview of the background and history of GAPA; describes GAPA and the council’s key achievements and milestones; places physical activity promotion within the global NCD agenda; presents GAPA flagships; and reflects on the lessons learned, ingredients for success and the major challenges that remain. The commentary documents insights into the effectiveness and challenges faced by a small non-governmental organisation (NGO) in mounting global advocacy. These lessons may be transferrable to other areas of health promotion advocacy.

The Consortium for NCD Prevention and Control in Sub-Saharan Africa (CNCD-Africa): from concept to practice

CNCD-Africa was established in July 2009 in response to and in recognition of the continuously increasing burden of diseases such as injuries, non-communicable diseases (NCDs) and mental health in low- and middle-income countries, and specifically in countries of sub-Saharan Africa. CNCD-Africa aims to comprehensively address specific and common objectives while building capacity in the region to prevent and control NCDs. With support from key partners and funders, and a keen interest in opportunities to address NCDs from health promotion and equity perspectives, the Consortium has excelled in four key areas: convening; knowledge generation and sharing; advocacy; and networking. However, the path to successful and sustainable efforts remains laden with challenges and barriers. Retaining interest of network partners through flagship efforts and continued efforts to ascertain support from local and international partners with interest in NCDs across the region remain essential to CNCD-Africa core activities. A key lesson learnt from the early years of CNCD-Africa is that existing regional platforms can and should be used to showcase what is being done locally, and to share best practices and best-buys. In addition, partnerships and stakeholder involvement have been key for CNCD-Africa and are essential to NCD action. Sustaining such partnerships requires incentives for the various partners to keep actively involved in NCD action. This can be achieved through joint inception, project planning, implementation, monitoring and evaluation. Another ingredient for success seems to be innovative financing for NCD efforts, which is possible through the establishment and sustaining of regional and global partnerships that are robust, locally relevant and respond to country needs.

Road accidents: A third burden of 'disease' in sub-Saharan Africa

Road traffic injuries (RTIs) continue to be a major cause of death and disability throughout low- and middle-income countries (LMICs). The aim of this commentary is highlight some of the major causes of RTIs in sub-Saharan Africa and suggests strategies for better road safety as well as suggestions on how to reduce road accidents in LMICs.

Towards a global framework for capacity building for non-communicable disease advocacy in low- and middle-income countries

Non-communicable diseases (NCDs) represent an increasing proportion of morbidity and mortality throughout the world. Sustained advocacy, carried out by a skilled workforce, is an important strategy to realize the political will and implement the policy changes necessary to reduce the global burden of NCDs. Competencies for effective advocacy include a combination of scientific and technical as well as communication-based skills. Recognizing the need to build local capacity for NCD advocacy in low- and middle-income countries (LMIC), the International Union for Health Promotion and Education (IUHPE), the US Centers for Disease Control and Prevention (CDC), the National Heart Foundation of Australia and the InterAmerican Heart Foundation joined efforts to conduct two pilot advocacy courses, one in Thailand and one in Colombia. A Global Advisory Group engaged a Local Organizing Committee in each country to ensure the courses would meet the needs of the local stakeholders. While both courses contained a set of key competencies and helped participants develop joint strategies for moving forward with consensus advocacy targets, the courses differed in content and participant background depending on the local context. A key goal of the courses was to determine and describe the lessons learned and make recommendations for a framework to be used for future advocacy capacity-building activities in LMIC. The planning and execution of each course generated lessons in the following five areas that informed the development of a global framework for capacity building for NCD advocacy: 1) using a comprehensive theoretical framework to teach advocacy competencies, 2) engaging key stakeholders, 3) meeting local needs and priorities, 4) planning local logistics, and 5) ensuring the skills obtained through training are applied to sustained advocacy for NCDs.

Improving policy and practice to promote equity and social justice – a qualitative comparative analysis building on key learnings from a twinning exchange between England and the US

Community health promotion interventions, targeted at marginalised populations and focusing on addressing the social determinants of health (SDH) to reduce health inequalities and addressing the processes of exclusion, are an important strategy to prevent and control non-communicable diseases (NCDs) and promote the health of underprivileged and under-resourced groups. This article builds on key lessons learnt from a learning exchange between Communities for Health in England and the Racial and Ethnic Approaches to Community Health across the US (REACH US) communities that are tackling health inequities. It presents a qualitative analysis further capturing information about specific community interventions involved in the exchange and identifying lessons learnt. This exchange was led by a partnership between the US Centers for Disease Control and Prevention, the International Union for Health Promotion and Education, the Department of Health of England, Health Action Partnership International, and Learning for Public Health West Midlands. These efforts provide interesting insights for further research, priority areas of action for policy and practice to address the SDH and to promote and sustain equity and social justice globally. The article highlights some key lessons about the use of data, assets-based community interventions and the importance of good leadership in times of crisis and adversity. Whilst complex and time-consuming to arrange, such programmes have the potential to offer other countries including the global south new insights and perspectives that will in turn contribute to the SDH field and provide concrete strategies and actions that effectively reduce inequities and promote the health of our societies. The key learnings have the potential to contribute to the global community and growing documentation on evidence of effective efforts in the reduction of health inequities.

Case study: The Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020

This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury’s recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011–2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a ‘Safe System’ approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project’s development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

Commentary on a meeting entitled 'Building global capacity for non-communicable diseases (NCD) prevention: Defining direction and roles'.

This Commentary summarizes the key points that arose during a three-day meeting held in Atlanta in July 2012 on Building Global Capacity for NCD Prevention. A wide spectrum of participants representing many sectors of global health, including ministries of health from several low and middle-income countries (LMICs), governmental institutions, non-governmental organizations, national disease associations, academia, and global and regional institutions participated. Presentations and group discussions led to agreement on a number of actions that should be taken to increase capacity for coping with NCDs in LMICs. Key areas of discussion were on the role of research, workforce development, resources, and governance. While there was considerable agreement on what should be done, the workshop participants had difficulty in prioritizing these activities. This led to an agreement by the gathered participants that a follow-up Delphi study be conducted to help with prioritization.

Learning from communities in the USA and England to promote equity and address the social determinants of health

This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting ‘marginalised’ populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy. (Global Health Promotion, 2013; 20 Supp. 4: 104–112).

Health-promoting schools: working in partnership to address global needs, a collaboration leading to the production of practical tools for practitioners.

Modern schools do their best to motivate young people to live fulfilling, healthy and productive lives and the United Nations has put school education at the heart of the Millennium Development Goals. The context of education in schools is changing, but there is evidence from across the world that school health promotion can make a difference to health and education outcomes. The International Union for Health Promotion and Education (IUHPE) has recognized this potential in schools and, for the last five years in its work globally, has been actively engaged in strengthening efforts through successful partnerships. This commentary explores aspects of global partnerships in school health and the progress of the IUHPE’s leadership and partnership work in school health promotion. It also provides some reflections on what has been achieved to date and what might lie ahead in school health promotion globally.