Journal articles on the topic 'Project management – Malawi'

AbstractDespite the new development rhetoric emphasising sustainability, preservationof biodiversity, natural resource management, income generation and participatory research, the new World Bank Malawi Fisheries Development Project represents a continuation of past practices. This article examines the underlying conceptual framework and implications of this World Bank project in the light of research among fishing communities on Lake Malawi. The Bank, it is argued, is mistakenly promoting assistance to the large-scale commercial fishing sector rather than attempting to implement more innovative and collaborative project initiatives with small-scale fishers, processors and traders who comprise the vast majority of lake users.

Abstract. UP4DREAM (UAV Photogrammetry for Developing Resilience and Educational Activities in Malawi) is a cooperative project cofounded by ISPRS between the Polytechnic University of Turin and the United Nations Children Fund (UNICEF) Malawi, with the support of two local Universities (Lilongwe University of Agriculture and Natural Resources, and Mzuzu University), and Agisoft LLC (for the use of their photogrammetry and computer vision software suite). Malawi is a flood-prone landlocked country constantly facing natural and health challenges, which prevent the country's sustainable socio-economic development. Frequent naturals shocks leave vulnerable communities food insecure. Moreover, Malawi suffers from high rates of HIV, as well as it has endemic malaria. The UP4DREAM project focuses on one of the drone project's critical priorities in Malawi (Imagery). It aims to start a capacity-building initiative in line with other mapping missions in developing countries, focusing on the realization and management of large-scale cartography (using GIS - Geographic Information Systems) and on the generation of 3D products based on the UAV-acquired data. The principal aim of UP4DREAM is to ensure that local institutions, universities, researchers, service companies, and manufacturers operating in the humanitarian drone corridor, established by UNICEF in 2017, will have the proper knowledge and understanding of the photogrammetry and spatial information best practices, to perform large-scale aerial data acquisition, processing, share and manage in the most efficient, cost-effective and scientifically rigorous way.

Gender mainstreaming in the water sector in Malawi was analyzed using the Mzimba Integrated Rural Water Supply and Sanitation (IRWSS) project as a case in point. Information required for the study was obtained through interviews, administering a set of questionnaires and data collecting from existing documents. The results show that women in decision-making positions at head office of the Ministry responsible for water affairs only constitute about 11.1%. Assessment of the budget allocations has revealed that previously no budgetary allocations were made for gender issues, and that since the 2006/07 fiscal year about US$14,286 was allocated for gender mainstreaming. Women's involvement in local governance institutions and project activities in Mzimba is generally high. Most local water committees have 60% women and 40% men, whereas participation in project activities is highly rated at 97.2%. To improve gender balance, the Ministry responsible for water has to work with stakeholders in the education sector. Besides, great disparities still exist between men's and women's participation in water projects at a local level (97.2% for women) and a person's socioeconomic position greatly affects their inclusion in the local governance structures. Addressing these issues would, therefore, result in better gender integration in the water sector.

PurposeThe purpose of this research is to identify ways in which medical record keeping systems and health information systems might be integrated effectively and sustainably. The aims include minimising the workload of busy frontline health professionals and radically improving data quality. Design/methodology/approachThis is a qualitative research project, grounded in the theoretical stance that information systems are sociotechnical systems. The primary focus of this research is on real-life custom and practice. The study population consisted of participants in information systems. As is common in qualitative research, sampling was purposive rather than statistically representative. FindingsThis research suggests one unconventional conclusion. New approaches that use intermediate and hybrid technologies may have a better prospect of delivering satisfactory, realistic and affordable medium- to long-term solutions than strategies predicated on the assumption that only systems that are wholly electronic are worth considering. Originality/valueThis research is original in the sense that it investigated records rather than information technology systems. The findings are likely to be of applicability in other developing countries, especially those that share legacy systems with Malawi, such as Botswana, Tanzania, Zambia and Zimbabwe.

SUMMARYSmallholder farmers in Malawi are faced with the challenge of managing complex and dynamic farming systems while also adapting to change within volatile agroecological conditions. Moreover, management decisions are influenced by a combination of local knowledge, expert recommendations and on-farm experimentation. Although many smallholder farmers actively experiment with new crops and technologies, little is known about the prevalence of experimentation or the types of experiments farmers conduct. This study examined the decision-making processes of experimenting farmers to explore the drivers of on-farm experimentation. Using a mixed-methods design that incorporated field observations, survey data and in-depth interviews, we identified numerous examples of experiments with new crops, varieties and techniques that had been executed either independently or through participation in an agricultural development project. Results of quantitative and qualitative analysis reveal that smallholder farmers in Malawi across a range of socioeconomic characteristics are inclined to experiment, and gender roles in agricultural experimentation vary widely. While experimental methods differ between farmers, there are commonalities in the drivers of experimentation, including adapting to climate change, improving soil health, improving nutrition and generating income. Smallholders have a great capacity for experimentation, and their knowledge, experience, preferences and priorities – if properly understood and incorporated – could ultimately benefit both future agricultural development projects and their participants.

BackgroundThe global health community and funding agencies are currently engaged in ensuring that worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa.MethodsBetween January and March 2017, a qualitative approach was used to carry out and analyse 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions with regards to the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. ResultsOverall, our analysis found that the programme was successful in achieving its goals. However, there are many challenges to the wider implementation and sustainability of this programme, including the absence of monetary resources, limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management.ConclusionsFuture developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. These developments should also focus on building local capacity by educating trainers and ensuring that training methods and guidelines are appropriately accredited based on national policies. Our findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to develop an evidence-based policy for the utilization of technology for healthcare delivery across developing countries.

Climate compatible development (CCD) is gaining traction as a conceptual framework for mainstreaming climate change mitigation and adaptation within development efforts. Understanding whether and how CCD design processes reconcile different stakeholder preferences can reveal how the concept contends with patterns of sociocultural and political oppression that condition patterns of development. We, therefore, explore procedural justice and power within CCD design through a case study analysis of two donor-funded projects in Malawi. Findings show that donor agencies are driving design processes and involving other stakeholders selectively. While considerable overlap existed between stakeholders’ “revealed” priorities for CCD, invisible power dynamics encourage the suppression of “true” preferences, reducing the likelihood that CCD will be contextually appropriate and have widespread stakeholder buy in. Visible, hidden, and invisible forms of power create barriers to procedural justice in CCD design. We present five recommendations to help policy makers and practitioners to overcome these barriers.

Cooperation and locally driven water management are at the forefront of food production water management for smallholder farmers in low-income countries. The aim of this paper was to critically reflect on the experiences of 5,819 smallholder rice farmers in Karonga District, Malawi, who were members of a farmers’ organization that achieved improved water stewardship, but could not achieve Alliance for Water Stewardship certification within a three-year project. The data for this paper were obtained through farmer and stakeholder interviews. The partnership attempted to bring together four parties: academics, farmers, local government, and a non-governmental organization. The farmers were trained by combining stewardship and certification topics through a train-the-trainer approach. The farmers’ organization primarily focuses on agribusiness; therefore, they did not have any water-related data or detailed farm boundaries from the large and dispersed group of farmers and could not obtain a collective water permit. Understanding water governance was difficult for many farmers. Furthermore, moving from stewardship to certification presented some financial challenges. Critical thinking and questioning are required, along with a deeper understanding of the local context, logistical hindrances, priorities, alternatives, culture, and science, to evaluate how projects are designed and partially succeed or fail from the perspective of low-income farmers in the Global South.

The Kwithu project started when a volunteer who joined Kwithu, a community-based organization in Mzuzu, Malawi (Africa), to teach English gave a diagnostic test to a random group of forty 7th and 8th graders (20 boys and 20 girls) and discovered that most of them could hardly read or write in English. The test results prompted Maureen, the Kwithu director and co-founder, the teacher and myself to meet with the headteachers of the three schools mostly attended by Kwithu children. The headteachers appreciated our concerns about the English proficiency of the children, but they advised us to focus on more urgent matters if we truly wanted to help, e.g., lack of teaching and learning materials, lack of running water in schools, hunger, teacher qualifications, etc. This advice shifted our initial inquiry goal—from English language teaching—to a community-based participatory action research project designed to address the school conditions in Luwinga. In this paper, I describe the community-based participatory action research inquiry and I reflect on the process of participation.

SUMMARYAgricultural development projects frequently promote new crop production technologies for adoption at scale on the basis of research and pilot studies in a limited number of contexts. The performance of these production technologies is often variable and dependent on context. Using an example from the Agroforestry for Food Security Project in Malawi, that promoted agroforestry technologies for soil fertility enhancement, we explore the nature and implications of variation in performance across farmers. Mean effects of these technologies, measured by differences in maize yield between agroforestry and sole maize plots, were modest but positive. However, there was large variation in those differences, some explained by altitude, plot management and fertilizer use but with much unexplained. This represents risk to farmers. Those communicating with farmers need to be honest and clear about this risk. It can be reduced by explanation in terms of contextual factors. This should be an aim of research that can often be embedded in scaling up the promotion of agronomic innovations.

Background Pneumonia is the leading infectious cause of death worldwide among children below 5 years of age. Clinical trials are conducted to determine optimal treatment; however, these trials often exclude children with comorbidities and severe illness. Conclusions Given the paucity of data from Africa, African-based research is necessary to establish optimal management of childhood pneumonia in malaria-endemic settings in the region. An expanded evidence base that includes children with pneumonia and other comorbidities, who are at high risk for mortality or have other complications and are therefore typically excluded from childhood pneumonia clinical trials, can contribute to future iterations of the World Health Organization Integrated Management of Childhood Illness guidelines. Methods The study enrolled 1000 children with pneumonia presenting to the outpatient departments of Kamuzu Central or Bwaila District Hospitals in Lilongwe, Malawi, who were excluded from concurrent randomized controlled clinical trials investigating fast breathing and chest indrawing pneumonia and who met the inclusion criteria for this prospective observational study. Each child received standard care for their illnesses per Malawian guidelines and hospital protocol and was prospectively followed up with scheduled study visits on days 1, 2 (if hospitalized), 6, 14 (in person), and 30 (by phone). Our primary objectives are to describe the clinical outcomes of children who meet the inclusion criteria for this study and to investigate whether the percentages of children cured at day 14 among those with either fast breathing or chest indrawing pneumonia and comorbidities such as severe malaria, anemia, severe acute malnutrition, or HIV are lower than those in children without these comorbidities in the standard care groups in concurrent clinical trials. This study was approved by the Western Institutional Review Board, Malawi College of Medicine Research and Ethics Committee, and the Malawi Pharmacy, Medicines and Poisons Board. Objective This prospective observational study aimed to assess the clinical outcomes of children aged 2-59 months with both pneumonia and other comorbidities in a malaria-endemic region of Malawi. Results The Innovative Treatments in Pneumonia project was funded by the Bill and Melinda Gates Foundation (OPP1105080) in April 2014. Enrollment in this study began in 2016, and the primary results are expected in 2019. International Registered Report Identifier (IRRID) DERR1-10.2196/13377

Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. Methods This study is part of the “Integrating a neonatal healthcare package for Malawi” project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). Findings A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. Conclusion Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.

This article highlights evidence and lessons learned from the InnovAfrica project conducted by the Agricultural Research Council in collaboration with other international organizations between 2017 and 2021. This project aimed to test and upscale best-bet Sustainable Agricultural Intensification (SAI) practices through Multi-Actor Platforms (MAPs) and improved dissemination strategies across six African countries (viz. Ethiopia, Kenya, Malawi, Rwanda, South Africa and Tanzania). The goal of the project was to improve the food and nutritional security of smallholder farmers in Africa. The article briefly discusses some of the key challenges that smallholder agriculture is facing, results from the agricultural interventions brought in by the InnovAfrica project, evidence-based actions and policy recommendations to improve the sustainable agricultural productivity of smallholder farmers in the South African case study. The study showed that SAI practices increased crop yields and build climate-resilient farming communities. It is recommended that the promotion of SAI practices should be supported by enabling institutions and conducive policies that will enhance access to inputs, market linkages, improved access to credit and good agricultural lands, the establishment of functional farmer groups and participatory learning models. These recommendations can be used by the government and other agencies to develop effective interventions to improve food and nutrition security.

Purpose The purpose of this paper is to describe progress in an across sectorial approach to primary health care at the district health service (DHS) level in Thailand in response to recent innovative national public policy directions which have been enshrined in constitutional doctrine and publicly endorsed by the Prime Minister. This paper describes one response to the Prime Minister’s challenge for Thailand to become the centre of learning in the sub-region in health management. Design/methodology/approach The authors utilised a descriptive case study approach utilising an analysis of the Naresuan University initiative of establishing the College of Health Systems Management (NUCHSM). Within that case study, there is a focus on challenges relevant to the socio-economic determinants of health (SOED) and an emphasis on utilising Sustainable Development Goals (SDGs) within the DHS structure. Findings The findings describe the establishment of the NUCHSM. A Master of Science (Health Systems Management) by research and a PhD degree have been created and supported by an international faculty. The Thailand International Cooperation Agency recognised NUCHSM by providing scholarships. International students are from Bangladesh, Bhutan, Kenya, Malawi and Timor Leste. Research consultancy projects include two in Lao People’s Democratic Republic; plus, a prototype DHS management system responsive to SDG attainment; and a project to establish a sustainable Ageing Society philosophy for a Thai municipality. Originality/value The case study on NUCHSM and its antecedents in its development have demonstrated originality in a long-standing international collaboration, and it has been recognised by the national government to provide scholarships to citizens of the countries in the sub-region to undertake postgraduate studies in health management. The concept of learning from each other and together, simultaneously as a group, through action research projects funded to enhance the evolution of DHSs is innovative.

The on-going debate on aid effectiveness highlights that in order for capacity development interventions to remain relevant and their results sustainable, their planning, implementation, monitoring and evaluation need to be flexible and case-specific. It is not only important to account for end results, but also to adjust interventions during their implementation. Capacity development partnerships (CDP) between water operators are portrayed as a promising approach for sustained performance. However, it has been observed that these interventions require significant time to lead to the targeted water operator performance gains. Hence, managing the partnership solely through the use of key performance indicators offers the partners little insight into both the progress achieved and the effectiveness of the partnership activities in contributing to such progress. This incomplete picture is likely to limit the ability of partners to manage the project efficiently. This paper proposes a multi-path approach to monitoring and evaluating the performance of CDPs (this being understood as different from the performance of the targeted water operator) that enables well-informed management of the partnership. The designed approach is applied to compare the progress of two partnership projects, namely those of the Lilongwe and Blantyre Water Boards in Malawi, with Vitens Evides International.

Many practical and action-oriented international roadmaps to improve the quality of aid and its delivery and impact on development—including the Paris Declaration, Accra Agenda for Action, and Busan Partnership—emphasize a more active involvement of domestic institutions and procedures. Despite widespread agreement among both donor and recipient countries on this issue, we find that aid often tends to bypass national institutional structures. This practice is sometimes justified on grounds of high levels of political and administrative corruption and weak implementation capacity in recipient country bureaucracies. We examine how and to what extent multilateral and bilateral development agencies bypass national and local government institutions while channeling aid and the impact of such practices on aid effectiveness in Africa. Based on an empirical study of project aid and budget support provided to Malawi by the World Bank, the African Development Bank, and the German Economic Group, we argue that earmarked funding, specialized procurement arrangements, and the proliferation of Project Management Units are among the mechanisms used to circumvent the involvement of national institutions. We conclude that while such practices may achieve short-term gains by displaying successful and visible ‘donorship’, the long-term impact is more uncertain. The bypassing of local institutions results in fragmentation of aid, lack of coordination among aid industry actors, and a general weakening of policy space and domestic capacity to formulate and implement development policy.

Bioenergy can play an important role in achieving the agreed United Nations Sustainable Development Goals (SDGs) and implementing the Paris Agreement on Climate Change, thereby advancing climate goals, food security, better land use, and sustainable energy for all. In this study, we assess the surplus agricultural residues availability for bioelectricity in six least developed countries (LDCs) in Asia and Africa, namely Bangladesh, Lao-PDR, and Nepal in Asia; and Ethiopia, Malawi, and Zambia in Africa, respectively. The surplus agricultural residues have been estimated using residue-to-product ratio (RPR), agricultural residues lost in the collection, transportation and storage, and their alternative applications. We use a linear regression model to project the economic potential of bioelectricity. The contribution of bioelectricity for meeting the LDCs’ electricity requirements is estimated in a time frame between 2017 and 2030. Our results reveal that the surplus biomass feedstock available from the agriculture sector could provide the total current electricity demand in Malawi alone, followed by Nepal (45%), Bangladesh (29%), Lao People’s Democratic Republic (Lao-PDR) (29%), Ethiopia (27%), and Zambia (13%). This study also explores the complementarity and synergies of bioelectricity, SDG7, and their interlinkages with other SDGs. Findings from the study show that providing access to sustainable energy in the LDCs to meet the SDG7 by 2030 might be a challenge due to limited access to technology, infrastructure, and finance. Site-specific investigations on how much agricultural residues could be extracted in an environmentally benign manner for bioelectricity and increased investment in the bioenergy sector are key potential solutions in a myriad of options required to harness the full energy potential in the LDCs.

The purpose of this study was to assess women’s decision-making power in small-scale agriculture in six African countries in view of the feminization of agriculture and to discuss the meaning of decision-making in relation to women’s empowerment and sustainability. The data are drawn from a multisite and mixed-method agricultural research and development project in six sub-Saharan countries including two sites in each country. The five domains of empowerment outlined in the Women’s Empowerment in Agriculture Index are used to structure the analysis. The results indicate that in the selected sites in Malawi, Rwanda and South Africa, women farmers tend to dominate agricultural decision-making, while the result is more mixed in the Kenyan sites, and decision-making tends to be dominated by men in the sites in Tanzania and Ethiopia. Despite women participating in agricultural decision-making, the qualitative results show that women small-scale farmers were not perceived to be empowered in any of the country sites. It appears that the feminization of agriculture leads to women playing a more important role in decision-making but also to more responsibilities and heavier workloads without necessarily resulting in improvements in well-being outcomes that would enhance sustainability.

Abstract To eliminate lymphatic filariasis (LF) by 2020, the World Health Organization (WHO) has launched a campaign against the disease. Since the launch in 2000, significant progress has been made to achieve this ambitious goal. In this article we review the progress and status of the LF programme in Africa through the WHO neglected tropical diseases preventive chemotherapy databank, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) portal and other publications. In the African Region there are 35 countries endemic for LF. The Gambia was reclassified as not requiring preventive chemotherapy in 2015, while Togo and Malawi eliminated LF as a public health problem in 2017 and 2020, respectively. Cameroon discontinued mass drug administration (MDA) and transitioned to post-MDA surveillance to validate elimination. The trajectory of coverage continues to accelerate; treatment coverage increased from 0.1% in 2000 to 62.1% in 2018. Geographical coverage has also significantly increased, from 62.7% in 2015 to 78.5% in 2018. In 2019, 23 of 31 countries requiring MDA achieved 100% geographic coverage. Although much remains to be done, morbidity management and disability prevention services have steadily increased in recent years. Vector control interventions conducted by other programmes, particularly malaria vector control, have had a profound effect in stopping transmission in some endemic countries in the region. In conclusion, significant progress has been made in the LF programme in the region while we identify the key remaining challenges in achieving an Africa free of LF.

Purpose The purpose of this paper is to discuss the role of languages and translation in the context of capacity building in NGOs in Kyrgyzstan. It argues that language barriers can impede local capacity building, while translation can help in overcoming some of the issues encountered. Design/methodology/approach The paper reports on what NGO workers have said on the role of languages and translation in their work in 34 semi-structured interviews conducted in Kyrgyzstan in January 2018. The discussion is structured around a theoretical understanding of capacity building at three levels: the organisational level, the individual level and a broader enabling environment. Findings First, the paper demonstrates that knowledge of English plays a key role in accessing international funding and information. Second, it describes the challenges that NGO workers encounter when translating information related to development into Russian and Kyrgyz. Third, it argues that donors do not overtly consider the important role of languages. Together, the findings suggest that ignoring the role of languages and translation can have a negative effect on project outcomes and power relationships. Practical implications Policy recommendations for international NGOs and donors drawn from this case study and from comparative case studies on Peru and Malawi have been published in Crack et al. (2018). Originality/value The paper argues that taking the role of languages and translation into account can result in a more in-depth understanding of aspects that may contribute to better local capacity building.

In many public health and medical research settings, information on key covariates may not be readily available or too expensive to gather for all individuals in the study. In such settings, the two-phase design provides a way forward by first stratifying an initial (large) phase I sample on the basis of covariates readily available (including, possibly, the outcome), and sub-sampling participants at phase II to collect the expensive measure(s). When the outcome of interest is binary, several methods have been proposed for estimation and inference for the parameters of a logistic regression model, including weighted likelihood, pseudo-likelihood and maximum likelihood. Although these methods yield consistent estimation and valid inference, they do so solely on the basis of the phase I stratification and the detailed covariate information obtained at phase II. Moreover, they ignore any additional information that is readily available at phase I but was not used as part of the stratified sampling design. Motivated by the potential for efficiency gains, especially concerning parameters corresponding to the additional phase I covariates, we propose a novel augmented pseudo-likelihood estimator for two-phase studies that makes use of all available information. In contrast to recently-proposed weighted likelihood-based methods that calibrate to the influence function of the model of interest, the methods we propose do not require the development of additional models and, therefore, enjoy a degree of robustness. In addition, we expand the broader framework for pseudo-likelihood based estimation and inference to permit link functions for binary regression other than the logit link. Comprehensive simulations, based on a one-time cross sectional survey of 82,887 patients undergoing anti-retroviral therapy in Malawi between 2005 and 2007, illustrate finite sample properties of the proposed methods and compare their performance competing approaches. The proposed method yields the lowest standard errors when the model is correctly specified. Finally, the methods are applied to a large implementation science project examining the effect of an enhanced community health worker program to improve adherence to WHO guidelines for at least four antenatal visits, in Dar es Salaam, Tanzania.

PURPOSE Nursing specialization in the care of children with cancer provides the foundation for implementing successful pediatric oncology treatment programs throughout the world. Whereas the burden of childhood cancer care is highest in low- and middle-income countries (LMICs), opportunities for continuing nursing specialization are extremely limited. The Global HOPE Initiative, part of Texas Children’s Hospital in Houston, TX, has developed and implemented a distance-based training program for nurses working in sub-Saharan Africa. METHODS After a needs assessment, the program was developed using the Internet-based, open-sourced education platform, MOODLE. MOODLE is an acronym for Modular Object-Oriented Dynamic Learning Environment, an online learning management system that provides custom learning environments. As Internet access can be difficult at the clinical sites, computer tablets are provided with all educational materials downloaded from the MOODLE learning site. Courses are taught using a modular approach and core competencies established for each module. Zoom and WhatsApp technologies are used for shared learning discussions. A Project ECHO (Extension for Community Healthcare Outcomes) for Global HOPE Nursing was implemented monthly to support the growth of the distance-based learning network. RESULTS This distance-based education program teaches the principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana, where 35 nurses are now enrolled. Formal course evaluation includes written pre- and post-tests and simulated checkoffs on essential pediatric oncology nursing competencies, such as chemotherapy administration. Sixteen nurses have completed the program in the first year and significant improvement in knowledge, self-competency, and skills was found. CONCLUSION The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMICs to become full-time specialists in pediatric oncology nursing. Education programs that build capacity to develop specialists in pediatric oncology nursing are essential to improve global cure rates for children with cancer in LMICs.

Malawi entered a formalisation of a decentralised administration structure through the enactment of the Local Government Act of 1998. The environmental implications and obligations are stated in the Environmental Management Act 1996, which also mandates the Environmental Affairs Department as the co-ordinator for environmental management. Both acts devolve environmental management responsibilities to the District Assemblies. Donors (i.e., UNDP and DANIDA) sponsored and facilitated environmental management decentralisation through projects that strengthened legal and institutional framework, and built capacity. A few of lessons have been learnt from the process, and some are outlined in this paper e.g. the need for capacity building, harmonisation of the major statutes, and institutions where to anchor the mainstreamed decentralised environmental management functions. Other lessons include lack of delineation between devolution and deconcentration leading to local participation apathy, different policies among donor agencies resulted in implementation difficulties, and uncertainty in continuity of the initiative e.g. closure of DANIDA activities resulted in almost halt to the decentralisation of environmental management.

Maladie mentale et équilibre précaire, conditions de détention, réalisation du projet de soin, appréhension du placement en foyer, stigmatisation : ces facettes singulières s’expriment simultanément dans la prise en soin des patients Suisses détenus sous mesure pénale à des fins de placement institutionnel. Le malade psychique incarcéré sous article 59 du Code pénal suisse (20 % des détenus) voit sa peine suspendue au profit d’une incarcération dont la fin dépend, entre autres, de l’évolution du malade sur les critères de reconnaissance de la maladie et ceux de la dangerosité liée à la pathologie. Cette activité naissante (2012) s’adresse en premier lieu aux patients les plus démunis face aux changements (psychose, retard mental), le trouble psychique induisant souvent des mises en échec du patient face aux attentes de l’univers carcéral, incontournable pour accéder à la sortie. Cet accompagnement se veut lier des univers séparés par les murs, les prisons, les hôpitaux psychiatriques et les foyers et accompagner le détenu psychique à retrouver sa place dans la société. En s’appuyant notamment sur le concept de transition décrit par Meleis, et sur la gestion de situations complexes par la méthode de case management, cette liaison accompagne autant les soignants prenant en soin que les patients écroués soumis à cette complexité. Cette activité se trouve à la croisée du monde pénal et psychiatrique, soumis aux enjeux sociétaux actuels et majeurs en Suisse, la place du patient-détenu est un questionnement perpétuel pour eux comme pour nous, soignants. L’équipe actuelle se compose d’un infirmier case-manager de liaison et d’un psychiatre responsable du secteur psychiatrique dans une prison de haute sécurité ; l’activité se porte sur une mise en sens du parcours et du vécu auprès des patients, de coordination pour la cohérence des soins d’un milieu à l’autre.

Malawi is a country in sub-Saharan Africa bordering Mozambique, Tanzania and Zambia. It has an area of approximately 118000 km2 and is divided into northern, central and southern regions. It has an estimated population of 13 million, 47% of whom are under 15 years of age and just 5% over 60 years. Its economy is largely based on agriculture, with tobacco being the main export. The projected growth in gross domestic product (GDP) for 2007 was 8.8%; GDP per capita was $284 per annum.

Literature shows that much research has been conducted on the co-production of climate knowledge, but it has neither established a standardized and replicable model for the co-production process nor the emergent learning patterns as collaborators transition from the disciplinary comfort-zone (disciplinary and practice biases) to the transdisciplinary third-space. This study combines algorithmic simulation modelling and case study lessons from Learning Labs under a 4-year (2016–2019) climate change management project called Future Resilience of African CiTies and Lands in the City of Blantyre in Malawi. The study fills the research gap outlined above by applying a systems-approach to replicate the research process, and a Markov process to simulate the learning patterns. Results of the study make a number of contributions to knowledge. First, there are four distinct evolutionally stages when transitioning from the disciplinary comfort-zone to the transdisciplinary third-space, namely: Shock and resistance to change; experimenting and exploring; acceptance; and integration into the third-space. These stages are marked by state probabilities of the subsequent stages relative to the initial (disciplinary comfort-zone) state. A complete transition to the third-space is marked by probabilities greater than one, which is a system amplification, and it signifies that there has been a significant increase in learning among collaborating partners during the learning process. Second, a four-step decision support tool has been developed to rank the plausibility of decisions, which is very hard to achieve in practice. The tool characterizes decision determinants (policy actors, evidence and knowledge, and context), expands the determinants, checks what supports the decision, and then rates decisions on an ordinal scale of ten in terms of how knowledge producers and users support them. Third, for a successful transdisciplinary knowledge co-production, researchers should elucidate three system-archetypes (leverage points), namely: Salient features for successful co-production, determinant of support from collaborators, and knowledge co-production challenges. It is envisioned that academics, researchers, and policy makers will find the results useful in modelling and replicating the co-production process in a methodical and systemic way while solving complex climate resilience development problems in dynamic, socio-technical systems, as well as in sustainably mainstreaming the knowledge co-produced in policies and plans.

Purpose – In recent years, the concept of corporate social responsibility (CSR) has gained recognition and importance in both business and political settings. While considerable research has been conducted on CSR in developed countries, the extant literature on CSR in Sub-Saharan Africa (SSA) is scant and CSR is seen in terms of philanthropy. This paper aims to examine CSR from a broader perspective and in particular to identify the factors that hinder and promote CSR activities in SSA using the Smit (2009) CSR Value Chain Model. Design/methodology/approach – This paper is based on data obtained from a survey conducted by GTZ (now GIZ) on factors promoting and hindering CSR in SSA. The study surveyed 85 companies from six countries, namely; South Africa, Ghana, Kenya, Malawi, Mozambique and Namibia. The study essentially examined the internal and external CSR environments of the companies in the participating countries. Findings – The study revealed that there are nine key promoting and hindering factors of CSR for businesses in SSA. These include: leadership and governance, policy framework, project management, monitoring, evaluation and reporting, stakeholder engagement, staff engagement, government, funding and beneficiation. The study recommends a systemic and context-sensitive approach that relies on the potential of organisations and communities to design and implement their own solution within global frameworks in order to further develop CSR in the region. Research limitations/implications – There are a number of limitations in this study. First, this study did not include any informants from the responding organisations’ stakeholder groups, but relied mainly on information obtained from single respondents from organisations. Further research should include responses from other stakeholder groups. Practical implications – To promote or achieve the successful implementation of CSR and broaden its scope within the region beyond its current focus on philanthropy, managers must build bridges with their stakeholders through both formal and informal dialogues and engagement practices. Additionally, firms may enhance and maximise both social and economic value created when managers link their CSR activities to areas that improve firms’ long-term competitive potential by collectively and systematically applying their distinctive strengths to such activities in accordance with the value chain model. Originality/value – The finding in this study is novel and adds an important contribution to the developing CSR literature in the SSA region.

Most of the wild fish stocks in Malawi either are fully or over exploited. This challenge underpins importance of forecasting using available data to support sustainable fisheries management. The study aimed at modelling and forecasting Catfish (Mlamba) species yield from artisan fishery on Lake Malawi in Mangochi District as they are becoming important food fish due to decline of more important fish species such as Oreochromis(Chambo). The study was based on secondary data on fish catches between1976 and 2012, collected from Fisheries Research Unit of the Department of Fisheries in Malawi. The study considered Autoregressive Integrated Moving Average (ARIMA) processes to select an appropriate stochastic model for forecasting the species yield. Appropriate models were chosen based on ARIMA (p, d, q). Autocorrelation function (ACF), Partial autocorrelation (PACF), Akaike Information Criteria (AIC), Box-Ljung statistics, correlogram of residual errors, distribution of residual errors, ME, RMSE, MAPE and MAE. Selected model was ARIMA (0, 0, 1) for forecasting artisan landings of Catfish from Lake Malawi in Mangochi District from 2013 to 2022. Based on the chosen model, forecast for artisan Catfish landings showed mean of 352 tonnes and mean of actual catches was 362 tonnes. However, catches in year 2022 are projected to be 360 tonnes, slightly below the actual catches mean but above 236 tonnes in 2010, assuming other factors remain constant. Confidence intervals of the forecasts included a zero and as such over exploitation of the species cannot be ruled out. Landings of the fishery will increase to 360 tonnes and remain stable through year 2022 necessitating fisheries management consideration to improve the trend. Policy makers should secure sustainable exploitation of Catfish species, among artisan fishery in the study area by controlling all fishing effort that lands the species such as gillnets, beach seines, open water seines among others.

IntroductionA recent WHO multi-country study on maternal and newborn health concluded that there was no evidence of an association between high coverage with essential interventions and reduced mortality in health care facilities, or improvement in other outcomes.1 According to Horton the missing ingredient in this relation is quality of care.2 Quality improvement in healthcare has adopted techniques mainly from industries such as manufacturing and has been used widely in Europe and US. However, evidence of success of these techniques in healthcare is not very conclusive, especially in low and middle-income countries. There have been limited efforts to critically analyse the techniques used in quality improvement interventions. One of the main challenges in evaluating quality improvement is the complexity of the interventions themselves and the complex nature of the systems in which they are implemented. Robust evidence regarding quality improvement interventions for resource poor settings is generally lacking.The MaiKhanda trial looked at the effect of QI interventions and community women's groups on maternal and newborn mortality in 3 central districts in Malawi.3 The impact evaluation measuring effect on newborn mortality for the QI interventions, using a cluster RCT approach, remained inconclusive. We use a Theory-Based Evaluation (TBE) approach to understand why improvement interventions undertaken by MaiKhanda for new-born care did not show an effect. Absence of effect could be attributed to a failure of theory, a failure of implementation, an evaluation failure or a combination of these.Our primary objective was to understand the mechanisms by which the QI interventions worked (or not) and explore the interaction between the various factors that mediated the lack of effect on neonatal mortality that was observed in the cluster randomized control trial.MethodsOur research strategy consisted of developing a post-hoc Theory of Change, consolidating and synthesizing all the available evidence using an appropriate framework, and analysing the program and implementation theory using theory based approaches to evaluation.Data synthesis was conducted using the Consolidate Framework for Implementation Research (CFIR).4 The synthesis takes into consideration the various reports and documents accumulated through the life of the project and complements the process evaluation studies conducted during the same period. In doing so, it draws a picture of the intervention with a multi-dimensional perspective, which provides insights into the evolution of the project. The framework is very comprehensive covering 5 major domains and a range of constructs, not all of which were included in our study. As this was post-hoc analysis, the choice of constructs was based on the availability of data rather than prioritizing the key constructs to consider.CFIR helps to produce structured and comprehensive data that is then used for analysing the program theory in relation to the intervention outcome. The program theory thus generated for the MaiKhanda intervention is compared with the program theories of the Michigan Keystone Project, which used similar collaborative methods to successfully reduce their central venous line blood stream infections in 106 participating ICUs.5 The rationale for such a comparison is that while the interventions per se are very unique and specific to their context, the program theories underlying the use of collaborative methods in both the interventions is the same and therefore comparable. Theories offer a higher level of abstraction that can be comparable across different settings.6 ResultsThe key finding from analysis of the program theory is that similar intervention strategies that triggered successful mechanisms for improvement in the Keystone Project failed to generate such mechanisms in MaiKhanda project.The Model for Improvement used in MaiKhanda was built around Deming's improvement theory7 and Roger's diffusion of innovation theory.8 The former theory considers improvement as a product of subject matter knowledge and profound knowledge. Subject matter knowledge on essential and emergency newborn care was generally lacking among health care providers in Malawi. Similarly, understanding variations within the health systems is an acquired skill. While the implementing partners, provided ample opportunities for the Malawian health system to learn the Institute for Healthcare Improvement (IHI) model for improvement, in general, QI teams lacked capacity to collate data and analyse the variations between the health facilities. QI was a fairly new concept in Malawi and MaiKhanda's attempts to embed it within existing health system was limited by challenges of the health systems context, MaiKhanda's own organizational transition and QI and clinical capacity of health care providers.The main challenge for MaiKhanda was to simultaneously implement and sustain the various change packages it had introduced in the different facilities. While there were isolated instances of successful intervention activities within MaiKhanda, it did not build enough momentum to generate mechanisms across a critical mass of the facilities that would eventually result in improved newborn outcomes. This can be attributed to the implementation strength, context and complexity of MaiKhanda's interventions. This is explored further using the implementation theory.Implementation was based on diffusion theories where better performing facilities were to act as role models for other facilities to emulate. The cRCT design for measuring impact evaluation required a random allocation of the improvement facilities and this conflicted with innovation diffusion theories, which prescribed a gradual organic spread of the interventions by strategically engaging the innovators and early adapters.Limitations of the evaluation design notwithstanding, the implementation strength characterized by the dose, duration, intensity and specificity of the intervention was sub-optimal.Implementation strength is not the only factor triggering an intervention mechanism and cannot be measured independent of the intervention complexity or the intervention context. For example, MaiKhanda struggled to show an effect of its interventions, despite having a long pre-intervention period to refine its interventions, while the Michigan study produced results within 18 month period. This could be because of other factors related to intervention complexity such as the long implementation chain for intervention delivery, the subjective perception of the agency (QI teams) regarding QI and contextual factors such as organizational readiness, the health systems context, QI team capacity to deliver QI interventions and MaiKhanda's own internal capacity.Human agency is at the heart of implementation and the intervention required a continuous and prolonged time and effort, than was anticipated, to engage and train the health facility QI teams on the improvement model.One of the key factors affecting the uptake of strategies was MaiKhanda's positioning within the health system and the degree of influence it could exert on other actors. This factor has a significant role to play in country where projects are donor supported and perhaps also donor driven. The period of the intervention also saw MaiKhanda going through a period of rapid organizational transition, which affected intervention implementation on the ground. Furthermore, MaiKhanda's own understanding of QI concepts was evolving gradually and this coupled with its long implementation chain, influenced the subjective understanding of the QI teams regarding QI concepts. Health facility staff also lacked the necessary skills and knowledge related to management of newborn health.Limited resources within the health facilities meant that gains achieved in some aspects of the intervention could not be sustained in the long run. External contextual factors such as fuel shortages contributed to poor implementation. Changes in policy such as government ban on TBAs, affected intervention uptake and resulted in an increase in health facility deliveries, overwhelming the already under-resourced staff capacity in the health facilities. It is conceivable that quality improvement was not on top of their priority list. But, ‘motivation’ to be involved in QI Collaboratives remained high. In resource constrained settings, ‘motivation’ can be influenced by the lure of personal incentives (such as per diems for attending workshops and meetings) as much as individual's commitment to broader social gains (ie reduction in newborn case fatality rates in their facility). The improvement model was competing against other existing models and it was difficult to get enough stakeholder commitment to the prescribed model as there were huge expectations fuelled by the poverty and poor governance structures and a culture of “perdiemitis” was prevalent in Malawian health care system.9 DiscussionAs is evident from the study, a single research method will not be able to provide justice to evaluation of a complex set of factors that influence newborn outcomes. We propose a research strategy that includes developing a Theory of Change, followed by evaluation of the program theory, measuring implementation strength, analysing implementation theory and comparing this in relation to the outcomes of the intervention observed through the impact evaluation. The results arising from such a comprehensive evaluation will contribute to the growth of improvement science with the accumulation of knowledge and explanation rather than being just a bedrock of observational facts.More generally, we propose that design, implementation and evaluation of QI activities, particularly in resource-poor settings, should consider five key principles i.e it should include whole systems thinking, accountability, participatory approach, should be evidence-based and adapt innovative methods.10

Increasingly common methods for financing public infrastructure in developing economies are Resources-for-Infrastructure (R4I) and Resource-Financed Infrastructure (RFI), usually involving Chinese financial institutions and Chinese construction companies. Although there are advantages to the borrowing country from these project financing arrangements, there are also various issues and governance challenges. In Uganda, expectations around future revenue from oil extraction have led to many infrastructure projects being commissioned, mostly funded by RFI arrangements. To consider the appropriateness of these arrangements and to reflect on whether they are likely to contribute to positive development outcomes or be examples of the resource curse, we examined four public infrastructure projects: Kampala–Entebbe Expressway; Karuma Hydroelectric Dam; Isimba Hydroelectric Dam; and the Malaba to Kampala section of the East Africa Standard Gauge Railway. Although R4I/RFI arrangements are viewed positively by some commentators, others (especially local companies) consider they lack transparency, create unsustainable debt, promote China’s interests over the borrowing country, increase unemployment, unfairly compete with local business, deal in corruption, have poor working conditions, and result in substandard construction. Nevertheless, we conclude that Uganda and other developing countries have generally benefited from Chinese-funded infrastructure, and there is more myth trap than debt trap. However, to ensure positive development outcomes, governments and construction companies should ensure compliance with international standards, especially relating to: environmental and social impact assessment; human rights; benefit-sharing arrangements; livelihood restoration; and project-induced displacement and resettlement.

In implementing rural development projects, African states expect that the otherwise poor peasantry would respond positively by maximising use of the productivity-enhancing technologies available to them, in order to improve their income status. The basic requirement is that the producer must supply significantly higher levels of productive labour-time, mainly from subsistence production and other traditional activities. The Malawi experience suggests that this process revolves around the critical role of both the physical and psychological dimensions of labour-time application. Therefore, the transformation of peasant commodity-surplus producers is unlikely to be effectively achieved, unless attainable commodity income is sufficient to at least support both customary production and subjectively defined socio-economic goals.

Buildings account for about 40% of the global energy consumption and this energy demand is projected to continue growing over the next few decades. Residential buildings are responsible for over 60% of this consumption pattern with commercial buildings being responsible for the remainder. While residential building energy consumption constitutes about 20% of the total consumption in the developed world, it constitutes up to more than 50% in the sub-Sahara African region. The growing consumption of energy has raised concerns over the impacts on the environment, supply difficulties, and depletion of resources. In efforts toward addressing these concerns, the need for effective management of energy resources and adequate planning for energy infrastructure cannot be overemphasized within the building industry in general and the residential building sector in particular. Toward this end, it is necessary to ensure that high quality and high-resolution information on the consumption of energy in buildings is made available. Unfortunately, in many countries within the sub-Sahara African region, building energy consumption information is hardly ever readily available. This study seeks to make a contribution toward this facet of the literature at the greater regional level in general and particularly, in Malawi, a country located in the southern part of Africa. With a grounding in the context of urban residential buildings, the study identifies the key energy end-uses, investigates the proportional mixes of the end-uses and the energy sources and, finally, establishes the periodical per capita energy consumption amounts for the end-uses and the typical residential building unit.

The most conventional systems in the Urban Planning practice leave out needs and real social demands through inefficient management models in many cases. Nowadays there is a social, professional and institutional demand to transform these models into new ways of thinking and planning the city that are closer to its inhabitants. In fact, there is a high social involvement of people that are helping or developing activities in favour of their local communities. However, this social activism is not visible nor recognised as the one made by regulated associations. Undoubtedly, the use of new technologies offers a framework of opportunity in these new ways of ”making the city”, as well as it becomes a new area of work and research.In this sense, there are many experiences that incorporate technology as a resource to promote citizen participation in the management of cities. However, only some of them are effective and achieve the goal of becoming a useful tool for citizens. In the city of Malaga, there are already some digital tools at the service of citizenship, although these require a process of revision and updating that allows optimizing existing resources and increasing their impact as a participation tool. As a first step, it is necessary to identify the agents and social initiatives of existing participation in the city.The objective of this project is to create an interactive digital platform that shows the city of Malaga from a real social perspective, as it makes visible and map the emerging non regulated movements, neighbourhood initiatives and new urban trends with low visibility. Finally, the aim is to create a tool for collectives, associations, administrations and other urban agents to promote synergies and relationships among all of them. The incorporation of all of them is essential for the success of the platform as a participation tool. For this, a methodology of actions is established, and it begins with the identification of possible agents and the way of interaction with each one of them. The digital tool that is used is based on the use of geographic location systems.This article collects the results of the first phase of the research project that includes a methodological proposal for mapping the real social activist reality in cities and a functional test of the digital platform created for this. Likewise, an evaluation of the experience and possible improvements to be incorporated in the successive phases of the project is advanced

Résumé Cet article rend compte des principaux résultats d'un projet du CLSC des Faubourgs1 portant sur l'intervention auprès des personnes itinérantes souffrant de troubles mentaux graves et persistants. Le projet comporte deux volets : une recherche qui décrit les personnes itinérantes fréquentant les urgences psychiatriques de garde à Montréal et les services qui leur sont dispensés et un projet pilote d'intervention auprès d'un échantillon de la population. La première partie de l'article présente les résultats de la recherche et aborde la question de l'accessibilité de la population aux services psychiatriques et les multiples difficultés reliées, d'une part, aux personnes, à leur maladie, à leurs conditions de vie et à leur résistance aux soins et, d'autre part, à l'organisation des services du réseau de la santé et des services sociaux et à l'existence de ressources dans la communauté pour cette population. La deuxième partie de l'article décrit et évalue sommairement une expérimentation de suivi systématique individuel (case management) et s'intéresse à la question de l'approche d'intervention à privilégier auprès de la population compte tenu de ce qui précède.

Background: von Hippel–Lindau (VHL) disease is an autosomaldominant condition characterized by the development of benignand malignant tumours, including cases of renal cell carcinoma(RCC). Early detection of RCC through routine surveillance canlead to decreased morbidity and mortality. Data on the numberof patients in Nova Scotia (NS) who have VHL disease, diseasemanifestations and the frequency and mode of the surveillancehave not previously been collected or reported. This project wasdesigned to obtain that information.Methods: The number and management of patients with VHL diseasewas determined by multiple sources: the Maritime MedicalGenetics Service, patient charts, and pathology, radiology and laboratorydata. The actual surveillance being performed was comparedwith that recommended in the literature.Results: Twenty-one patients from 11 families in NS were identified.Manifestations included cases of RCC (31.6%), central nervoussystem (CNS) hemangioblastoma (73.7%), retinal hemangioma(47.4%), renal cyst (47.4%) and pheochromocytoma (10.5%).Of the 6 patients with RCC, 4 had bilateral tumours, 2 requiredkidney transplants and 1 developed metastatic disease. Routinesurveillance was being done for the CNS in 62.5% of patients,retina in 47.4%, abdomen in 43.8% and urine catecholaminesin only 10.5%. Only 1 of the 6 patients who developed RCCwas undergoing routine abdominal imaging. Surveillance investigationswere ordered by a number of different specialists.Conclusion: Patients with VHL disease in NS have a number of manifestationsassociated with their disease, including RCC, in a similarfrequency to that reported in the literature. The surveillanceof these patients is suboptimal in frequency and coordination.von Hippel–Lindau disease is a complex condition that requiresa coordinated approach to care to ensure proper surveillance andtreatment. Our study highlights current deficiencies and offersan enormous opportunity for improvement.Généralités : La maladie de von Hippel-Lindau (VHL) est une maladieà transmission autosomique dominante caractérisée par la formationde tumeurs bénignes et malignes, dont l’hypernéphrome.Le dépistage précoce de l’hypernéphrome par des examens régulierspeut amener une réduction de la morbidité et de la mortalité. Onne sait pas combien de personnes sont atteintes de VHL enNouvelle-Écosse, quelles sont les manifestations de la maladie chezces patients et quels tests de dépistage sont effectués et à quellefréquence. Le projet décrit ici visait à obtenir ces renseignements.Méthodologie : Le nombre et la méthode de prise en charge despatients atteints de VHL ont été établis à l’aide de plusieurs sources :la Clinique de génétique médicale des Maritimes, des dossiers depatients, des rapports de pathologie et de radiologie et des analysesde laboratoire. Les méthodes de surveillance mises en placeont été comparées aux méthodes recommandées dans la littératuremédicale.Résultats : Vingt et un patients de 11 familles de Nouvelle-Écosseont été cernés. Les manifestations incluaient : hypernéphrome(31,6 %), hémangioblastomes siégeant au niveau du SNC (73,7 %),hémangiomes rétiniens (47,4 %), kystes rénaux (47,4 %) etphéochromocytomes (10,5 %). Sur les six patients porteurs d’unhypernéphrome, 4 avaient des tumeurs bilatérales, 2 ont eu besoind’une transplantation rénale et un patient a présenté des métastases.De tous les patients atteints de VHL, 62,5 % ont subi destests réguliers de dépistage au niveau du SNC, 47,4 %, au niveaude la rétine, 43,8 %, au niveau de l’abdomen, et seulement 10,5 %des patients ont subi des tests réguliers de dépistage des catécholaminesurinaires. Sur les 6 cas d’hypernéphrome, un seulementsubissait des épreuves régulières d’imagerie au niveau del’abdomen. Les tests de dépistage avaient été prescrits par différentsspécialistes.Conclusion : Les cas de VHL en Nouvelle-Écosse présentent un certainnombre de manifestations liées à cette maladie, dont l’hypernéphrome,à une fréquence proche de celle mentionnée dansla littérature. La fréquence et la coordination des épreuves dedépistage sont sous-optimales. La maladie de VHL est une affectioncomplexe nécessitant une bonne coordination des soinsafin d’assurer une surveillance et un traitement adéquats. Cetteétude montre les lacunes actuelles et pointe vers des améliorationssubstantielles.

Purpose The purpose of this paper is to identify the factors that affect TQM implementation in construction companies and it suggests solutions for TQM implementation in a difficult environment. Design/methodology/approach Studies were carried out at six large construction companies who ply their trade in Southern Africa and in-depth investigations were conducted to assess TQM implementation practices and associated TQM barriers. Interviews were conducted on directors and key personnel that play important roles in TQM implementation in their respective organisations. The empirical study also utilised a number of organisational documents which added rigour to the findings. Findings This study identified three core categories and ten main barriers affecting TQM implementation in Southern Africa construction companies. The core categories are motivation, infrastructure and penchants and tendencies while the factors are lack of quality support, poor TQM knowledge and TQM awareness, poor information sharing, temporary workers, overdependence on contract document, poor data collection measurement, undefined TQM roles and responsibilities, award to lowest bidder tendency, poor business environment and corruption. Research limitations/implications The study was conducted based on companies plying their trade in Southern Africa and mostly around Malawi, Zambia and Mozambique. It does not study companies in Namibia, Zimbabwe, Angola, South Africa and Botswana. Practical implications TQM cannot be exported wholly from another region to a new setting without taking into consideration the local factors associated with that setting. For successful TQM implementation in construction in Southern Africa, characteristics of this region have to be known. This study illuminates a number of TQM implementation barriers associated with construction especially applied to this difficult environment. Application of this knowledge would enhance TQM and heighten competitive advantage initiatives. The proportions highlighted in this study therefore help build up the TQM implementation awareness. Social implications At society level, the findings of this study indicate societal problems such as corruption and business environment which require wide level approaches to deal with these barriers. In addition, if TQM applied in road construction projects, the quality of the roads will be improved, this in turn will have direct impact on quality of life in the society, better roads means easier access to hospitals, schools and public places, better transport and movements of goods and services, etc. It can also save money for the country in long run and economic benefits to the society. Originality/value The factors identified in this study are based on current TQM implementation practices at established construction companies in Southern Africa. They provide a practical basis for guiding TQM in construction companies operating in difficult environments.

Reporting on the Sustainable Development Goals (SDGs) is complex given the wide variety of governmental and NGO actors involved in development projects as well as the increased number of targets and indicators. However, data on the wide variety of indicators must be collected regularly, in a robust manner, comparable across but also within countries and at different administrative and disaggregated levels for adequate decision making to take place. Traditional census and household survey data is not enough. The increase in Small and Big Data streams have the potential to complement official statistics. The purpose of this research is to develop and evaluate a framework to characterize a data ecosystem in a developing country in its totality and to show how this can be used to identify data, outside the official statistics realm, that enriches the reporting on SDG indicators. Our method consisted of a literature study and an interpretative case study (two workshops with 60 and 35 participants and including two questionnaires, over 20 consultations and desk research). We focused on SDG 6.1.1. (Proportion of population using safely managed drinking water services) in rural Malawi. We propose a framework with five dimensions (actors, data supply, data infrastructure, data demand and data ecosystem governance). Results showed that many governmental and NGO actors are involved in water supply projects with different funding sources and little overall governance. There is a large variety of geospatial data sharing platforms and online accessible information management systems with however a low adoption due to limited internet connectivity and low data literacy. Lots of data is still not open. All this results in an immature data ecosystem. The characterization of the data ecosystem using the framework proves useful as it unveils gaps in data at geographical level and in terms of dimensionality (attributes per water point) as well as collaboration gaps. The data supply dimension of the framework allows identification of those datasets that have the right quality and lowest cost of data extraction to enrich official statistics. Overall, our analysis of the Malawian case study illustrated the complexities involved in achieving self-regulation through interaction, feedback and networked relationships. Additional complexities, typical for developing countries, include fragmentation, divide between governmental and non-governmental data activities, complex funding relationships and a data poor context.

Studies on the adaptation from face-to-face to online teaching during lockdown show the before and after in education that faces the double challenge of promoting digital skills and public access to connectivity and electronic devices in the post-COVID-19 era. Therefore, this article contributes to these new emerging lines of educational research by presenting an educational innovation project called “Teachers Versus COVID-19”. This project aimed to verify whether the figure of teacher-prosumer, that is, consumers of media culture and creators of their own educational resources, favors the initial training of teachers during the pandemic. To this end, the following objectives were proposed: firstly, test whether the figure of the teacher-prosumer contributes to improving the adaptation of face-to-face teaching to the virtual modality of the Didactics of Social Sciences in the Degree in Primary Education during lockdown; secondly, analyze the production of content on social networks by the students in the Degree in Primary Education, according to the objectives of sustainable development. To validate our teacher-prosumer proposal, we chose the design-based research (DBR) qualitative methodology. For this, 240 students from the course in Didactics of Social Sciences of the Degree in Primary Education at the University of Malaga created 37 educational videos that teach the social sciences curriculum to children between 6 and 12 years of age from the perspective of relevant social problems and the Sustainable Development Goals. These videos were disseminated through the project’s YouTube channel. The results of this study corroborate the effectiveness of turning students into teachers-prosumers, generating the development of critical, creative, digital, and socio-emotional skills so that they feel committed to playing an active role in social changes for a sustainable world.

Education in Oceania continues to reflect the embedded implicit and explicit colonial practices and processes from the past. This paper conceptualises a cultural approach to education and leadership appropriate and relevant to the Republic of the Marshall Islands. As elementary school leaders, we highlight Kanne Lobal, a traditional Marshallese navigation practice based on indigenous language, values and practices. We conceptualise and develop Kanne Lobal in this paper as a framework for understanding the usefulness of our indigenous knowledge in leadership and educational practices within formal education. Through bwebwenato, a method of talk story, our key learnings and reflexivities were captured. We argue that realising the value of Marshallese indigenous knowledge and practices for school leaders requires purposeful training of the ways in which our knowledge can be made useful in our professional educational responsibilities. Drawing from our Marshallese knowledge is an intentional effort to inspire, empower and express what education and leadership partnership means for Marshallese people, as articulated by Marshallese themselves. Introduction As noted in the call for papers within the Waikato Journal of Education (WJE) for this special issue, bodies of knowledge and histories in Oceania have long sustained generations across geographic boundaries to ensure cultural survival. For Marshallese people, we cannot really know ourselves “until we know how we came to be where we are today” (Walsh, Heine, Bigler & Stege, 2012). Jitdam Kapeel is a popular Marshallese concept and ideal associated with inquiring into relationships within the family and community. In a similar way, the practice of relating is about connecting the present and future to the past. Education and leadership partnerships are linked and we look back to the past, our history, to make sense and feel inspired to transform practices that will benefit our people. In this paper and in light of our next generation, we reconnect with our navigation stories to inspire and empower education and leadership. Kanne lobal is part of our navigation stories, a conceptual framework centred on cultural practices, values, and concepts that embrace collective partnerships. Our link to this talanoa vā with others in the special issue is to attempt to make sense of connections given the global COVID-19 context by providing a Marshallese approach to address the physical and relational “distance” between education and leadership partnerships in Oceania. Like the majority of developing small island nations in Oceania, the Republic of the Marshall Islands (RMI) has had its share of educational challenges through colonial legacies of the past which continues to drive education systems in the region (Heine, 2002). The historical administration and education in the RMI is one of colonisation. Successive administrations by the Spanish, German, Japanese, and now the US, has resulted in education and learning that privileges western knowledge and forms of learning. This paper foregrounds understandings of education and learning as told by the voices of elementary school leaders from the RMI. The move to re-think education and leadership from Marshallese perspectives is an act of shifting the focus of bwebwenato or conversations that centres on Marshallese language and worldviews. The concept of jelalokjen was conceptualised as traditional education framed mainly within the community context. In the past, jelalokjen was practiced and transmitted to the younger generation for cultural continuity. During the arrival of colonial administrations into the RMI, jelalokjen was likened to the western notions of education and schooling (Kupferman, 2004). Today, the primary function of jelalokjen, as traditional and formal education, it is for “survival in a hostile [and challenging] environment” (Kupferman, 2004, p. 43). Because western approaches to learning in the RMI have not always resulted in positive outcomes for those engaged within the education system, as school leaders who value our cultural knowledge and practices, and aspire to maintain our language with the next generation, we turn to Kanne Lobal, a practice embedded in our navigation stories, collective aspirations, and leadership. The significance in the development of Kanne Lobal, as an appropriate framework for education and leadership, resulted in us coming together and working together. Not only were we able to share our leadership concerns, however, the engagement strengthened our connections with each other as school leaders, our communities, and the Public Schooling System (PSS). Prior to that, many of us were in competition for resources. Educational Leadership: IQBE and GCSL Leadership is a valued practice in the RMI. Before the IQBE programme started in 2018, the majority of the school leaders on the main island of Majuro had not engaged in collaborative partnerships with each other before. Our main educational purpose was to achieve accreditation from the Western Association of Schools and Colleges (WASC), an accreditation commission for schools in the United States. The WASC accreditation dictated our work and relationships and many school leaders on Majuro felt the pressure of competition against each other. We, the authors in this paper, share our collective bwebwenato, highlighting our school leadership experiences and how we gained strength from our own ancestral knowledge to empower “us”, to collaborate with each other, our teachers, communities, as well as with PSS; a collaborative partnership we had not realised in the past. The paucity of literature that captures Kajin Majol (Marshallese language) and education in general in the RMI is what we intend to fill by sharing our reflections and experiences. To move our educational practices forward we highlight Kanne Lobal, a cultural approach that focuses on our strengths, collective social responsibilities and wellbeing. For a long time, there was no formal training in place for elementary school leaders. School principals and vice principals were appointed primarily on their academic merit through having an undergraduate qualification. As part of the first cohort of fifteen school leaders, we engaged in the professional training programme, the Graduate Certificate in School Leadership (GCSL), refitted to our context after its initial development in the Solomon Islands. GCSL was coordinated by the Institute of Education (IOE) at the University of the South Pacific (USP). GCSL was seen as a relevant and appropriate training programme for school leaders in the RMI as part of an Asia Development Bank (ADB) funded programme which aimed at “Improving Quality Basic Education” (IQBE) in parts of the northern Pacific. GCSL was managed on Majuro, RMI’s main island, by the director at the time Dr Irene Taafaki, coordinator Yolanda McKay, and administrators at the University of the South Pacific’s (USP) RMI campus. Through the provision of GCSL, as school leaders we were encouraged to re-think and draw-from our own cultural repository and connect to our ancestral knowledge that have always provided strength for us. This kind of thinking and practice was encouraged by our educational leaders (Heine, 2002). We argue that a culturally-affirming and culturally-contextual framework that reflects the lived experiences of Marshallese people is much needed and enables the disruption of inherent colonial processes left behind by Western and Eastern administrations which have influenced our education system in the RMI (Heine, 2002). Kanne Lobal, an approach utilising a traditional navigation has warranted its need to provide solutions for today’s educational challenges for us in the RMI. Education in the Pacific Education in the Pacific cannot be understood without contextualising it in its history and culture. It is the same for us in the RMI (Heine, 2002; Walsh et al., 2012). The RMI is located in the Pacific Ocean and is part of Micronesia. It was named after a British captain, John Marshall in the 1700s. The atolls in the RMI were explored by the Spanish in the 16th century. Germany unsuccessfully attempted to colonize the islands in 1885. Japan took control in 1914, but after several battles during World War II, the US seized the RMI from them. In 1947, the United Nations made the island group, along with the Mariana and Caroline archipelagos, a U.S. trust territory (Walsh et al, 2012). Education in the RMI reflects the colonial administrations of Germany, Japan, and now the US. Before the turn of the century, formal education in the Pacific reflected western values, practices, and standards. Prior to that, education was informal and not binded to formal learning institutions (Thaman, 1997) and oral traditions was used as the medium for transmitting learning about customs and practices living with parents, grandparents, great grandparents. As alluded to by Jiba B. Kabua (2004), any “discussion about education is necessarily a discussion of culture, and any policy on education is also a policy of culture” (p. 181). It is impossible to promote one without the other, and it is not logical to understand one without the other. Re-thinking how education should look like, the pedagogical strategies that are relevant in our classrooms, the ways to engage with our parents and communities - such re-thinking sits within our cultural approaches and frameworks. Our collective attempts to provide a cultural framework that is relevant and appropriate for education in our context, sits within the political endeavour to decolonize. This means that what we are providing will not only be useful, but it can be used as a tool to question and identify whether things in place restrict and prevent our culture or whether they promote and foreground cultural ideas and concepts, a significant discussion of culture linked to education (Kabua, 2004). Donor funded development aid programmes were provided to support the challenges within education systems. Concerned with the persistent low educational outcomes of Pacific students, despite the prevalence of aid programmes in the region, in 2000 Pacific educators and leaders with support from New Zealand Aid (NZ Aid) decided to intervene (Heine, 2002; Taufe’ulungaki, 2014). In April 2001, a group of Pacific educators and leaders across the region were invited to a colloquium funded by the New Zealand Overseas Development Agency held in Suva Fiji at the University of the South Pacific. The main purpose of the colloquium was to enable “Pacific educators to re-think the values, assumptions and beliefs underlying [formal] schooling in Oceania” (Benson, 2002). Leadership, in general, is a valued practice in the RMI (Heine, 2002). Despite education leadership being identified as a significant factor in school improvement (Sanga & Chu, 2009), the limited formal training opportunities of school principals in the region was a persistent concern. As part of an Asia Development Bank (ADB) funded project, the Improve Quality Basic Education (IQBE) intervention was developed and implemented in the RMI in 2017. Mentoring is a process associated with the continuity and sustainability of leadership knowledge and practices (Sanga & Chu, 2009). It is a key aspect of building capacity and capabilities within human resources in education (ibid). Indigenous knowledges and education research According to Hilda Heine, the relationship between education and leadership is about understanding Marshallese history and culture (cited in Walsh et al., 2012). It is about sharing indigenous knowledge and histories that “details for future generations a story of survival and resilience and the pride we possess as a people” (Heine, cited in Walsh et al., 2012, p. v). This paper is fuelled by postcolonial aspirations yet is grounded in Pacific indigenous research. This means that our intentions are driven by postcolonial pursuits and discourses linked to challenging the colonial systems and schooling in the Pacific region that privileges western knowledge and learning and marginalises the education practices and processes of local people (Thiong’o, 1986). A point of difference and orientation from postcolonialism is a desire to foreground indigenous Pacific language, specifically Majin Majol, through Marshallese concepts. Our collective bwebwenato and conversation honours and values kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness) (Taafaki & Fowler, 2019). Pacific leaders developed the Rethinking Pacific Education Initiative for and by Pacific People (RPEIPP) in 2002 to take control of the ways in which education research was conducted by donor funded organisations (Taufe’ulungaki, 2014). Our former president, Dr Hilda Heine was part of the group of leaders who sought to counter the ways in which our educational and leadership stories were controlled and told by non-Marshallese (Heine, 2002). As a former minister of education in the RMI, Hilda Heine continues to inspire and encourage the next generation of educators, school leaders, and researchers to re-think and de-construct the way learning and education is conceptualised for Marshallese people. The conceptualisation of Kanne Lobal acknowledges its origin, grounded in Marshallese navigation knowledge and practice. Our decision to unpack and deconstruct Kanne Lobal within the context of formal education and leadership responds to the need to not only draw from indigenous Marshallese ideas and practice but to consider that the next generation will continue to be educated using western processes and initiatives particularly from the US where we get a lot of our funding from. According to indigenous researchers Dawn Bessarab and Bridget Ng’andu (2010), doing research that considers “culturally appropriate processes to engage with indigenous groups and individuals is particularly pertinent in today’s research environment” (p. 37). Pacific indigenous educators and researchers have turned to their own ancestral knowledge and practices for inspiration and empowerment. Within western research contexts, the often stringent ideals and processes are not always encouraging of indigenous methods and practices. However, many were able to ground and articulate their use of indigenous methods as being relevant and appropriate to capturing the realities of their communities (Nabobo-Baba, 2008; Sualii-Sauni & Fulu-Aiolupotea, 2014; Thaman, 1997). At the same time, utilising Pacific indigenous methods and approaches enabled research engagement with their communities that honoured and respected them and their communities. For example, Tongan, Samoan, and Fijian researchers used the talanoa method as a way to capture the stories, lived realities, and worldviews of their communities within education in the diaspora (Fa’avae, Jones, & Manu’atu, 2016; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014; Vaioleti, 2005). Tok stori was used by Solomon Islander educators and school leaders to highlight the unique circles of conversational practice and storytelling that leads to more positive engagement with their community members, capturing rich and meaningful narratives as a result (Sanga & Houma, 2004). The Indigenous Aborigine in Australia utilise yarning as a “relaxed discussion through which both the researcher and participant journey together visiting places and topics of interest relevant” (Bessarab & Ng’andu, 2010, p. 38). Despite the diverse forms of discussions and storytelling by indigenous peoples, of significance are the cultural protocols, ethics, and language for conducting and guiding the engagement (Bessarab & Ng’andu, 2010; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014). Through the ethics, values, protocols, and language, these are what makes indigenous methods or frameworks unique compared to western methods like in-depth interviews or semi-structured interviews. This is why it is important for us as Marshallese educators to frame, ground, and articulate how our own methods and frameworks of learning could be realised in western education (Heine, 2002; Jetnil-Kijiner, 2014). In this paper, we utilise bwebwenato as an appropriate method linked to “talk story”, capturing our collective stories and experiences during GCSL and how we sought to build partnerships and collaboration with each other, our communities, and the PSS. Bwebwenato and drawing from Kajin Majel Legends and stories that reflect Marshallese society and its cultural values have survived through our oral traditions. The practice of weaving also holds knowledge about our “valuable and earliest sources of knowledge” (Taafaki & Fowler, 2019, p. 2). The skilful navigation of Marshallese wayfarers on the walap (large canoes) in the ocean is testament of their leadership and the value they place on ensuring the survival and continuity of Marshallese people (Taafaki & Fowler, 2019; Walsh et al., 2012). During her graduate study in 2014, Kathy Jetnil-Kijiner conceptualised bwebwenato as being the most “well-known form of Marshallese orality” (p. 38). The Marshallese-English dictionary defined bwebwenato as talk, conversation, story, history, article, episode, lore, myth, or tale (cited in Jetnil Kijiner, 2014). Three years later in 2017, bwebwenato was utilised in a doctoral project by Natalie Nimmer as a research method to gather “talk stories” about the experiences of 10 Marshallese experts in knowledge and skills ranging from sewing to linguistics, canoe-making and business. Our collective bwebwenato in this paper centres on Marshallese ideas and language. The philosophy of Marshallese knowledge is rooted in our “Kajin Majel”, or Marshallese language and is shared and transmitted through our oral traditions. For instance, through our historical stories and myths. Marshallese philosophy, that is, the knowledge systems inherent in our beliefs, values, customs, and practices are shared. They are inherently relational, meaning that knowledge systems and philosophies within our world are connected, in mind, body, and spirit (Jetnil-Kijiner, 2014; Nimmer, 2017). Although some Marshallese believe that our knowledge is disappearing as more and more elders pass away, it is therefore important work together, and learn from each other about the knowledges shared not only by the living but through their lamentations and stories of those who are no longer with us (Jetnil-Kijiner, 2014). As a Marshallese practice, weaving has been passed-down from generation to generation. Although the art of weaving is no longer as common as it used to be, the artefacts such as the “jaki-ed” (clothing mats) continue to embody significant Marshallese values and traditions. For our weavers, the jouj (check spelling) is the centre of the mat and it is where the weaving starts. When the jouj is correct and weaved well, the remainder and every other part of the mat will be right. The jouj is symbolic of the “heart” and if the heart is prepared well, trained well, then life or all other parts of the body will be well (Taafaki & Fowler, 2019). In that light, we have applied the same to this paper. Conceptualising and drawing from cultural practices that are close and dear to our hearts embodies a significant ontological attempt to prioritize our own knowledge and language, a sense of endearment to who we are and what we believe education to be like for us and the next generation. The application of the phrase “Majolizing '' was used by the Ministry of Education when Hilda Heine was minister, to weave cultural ideas and language into the way that teachers understand the curriculum, develop lesson plans and execute them in the classroom. Despite this, there were still concerns with the embedded colonized practices where teachers defaulted to eurocentric methods of doing things, like the strategies provided in the textbooks given to us. In some ways, our education was slow to adjust to the “Majolizing '' intention by our former minister. In this paper, we provide Kanne Lobal as a way to contribute to the “Majolizing intention” and perhaps speed up yet still be collectively responsible to all involved in education. Kajin Wa and Kanne Lobal “Wa” is the Marshallese concept for canoe. Kajin wa, as in canoe language, has a lot of symbolic meaning linked to deeply-held Marshallese values and practices. The canoe was the foundational practice that supported the livelihood of harsh atoll island living which reflects the Marshallese social world. The experts of Kajin wa often refer to “wa” as being the vessel of life, a means and source of sustaining life (Kelen, 2009, cited in Miller, 2010). “Jouj” means kindness and is the lower part of the main hull of the canoe. It is often referred to by some canoe builders in the RMI as the heart of the canoe and is linked to love. The jouj is one of the first parts of the canoe that is built and is “used to do all other measurements, and then the rest of the canoe is built on top of it” (Miller, 2010, p. 67). The significance of the jouj is that when the canoe is in the water, the jouj is the part of the hull that is underwater and ensures that all the cargo and passengers are safe. For Marshallese, jouj or kindness is what living is about and is associated with selflessly carrying the responsibility of keeping the family and community safe. The parts of the canoe reflect Marshallese culture, legend, family, lineage, and kinship. They embody social responsibilities that guide, direct, and sustain Marshallese families’ wellbeing, from atoll to atoll. For example, the rojak (boom), rojak maan (upper boom), rojak kōrā (lower boom), and they support the edges of the ujelā/ujele (sail) (see figure 1). The literal meaning of rojak maan is male boom and rojak kōrā means female boom which together strengthens the sail and ensures the canoe propels forward in a strong yet safe way. Figuratively, the rojak maan and rojak kōrā symbolise the mother and father relationship which when strong, through the jouj (kindness and love), it can strengthen families and sustain them into the future. Figure 1. Parts of the canoe Source: https://www.canoesmarshallislands.com/2014/09/names-of-canoe-parts/ From a socio-cultural, communal, and leadership view, the canoe (wa) provides understanding of the relationships required to inspire and sustain Marshallese peoples’ education and learning. We draw from Kajin wa because they provide cultural ideas and practices that enable understanding of education and leadership necessary for sustaining Marshallese people and realities in Oceania. When building a canoe, the women are tasked with the weaving of the ujelā/ujele (sail) and to ensure that it is strong enough to withstand long journeys and the fierce winds and waters of the ocean. The Kanne Lobal relates to the front part of the ujelā/ujele (sail) where the rojak maan and rojak kōrā meet and connect (see the red lines in figure 1). Kanne Lobal is linked to the strategic use of the ujelā/ujele by navigators, when there is no wind north wind to propel them forward, to find ways to capture the winds so that their journey can continue. As a proverbial saying, Kanne Lobal is used to ignite thinking and inspire and transform practice particularly when the journey is rough and tough. In this paper we draw from Kanne Lobal to ignite, inspire, and transform our educational and leadership practices, a move to explore what has always been meaningful to Marshallese people when we are faced with challenges. The Kanne Lobal utilises our language, and cultural practices and values by sourcing from the concepts of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity). A key Marshallese proverb, “Enra bwe jen lale rara”, is the cultural practice where families enact compassion through the sharing of food in all occurrences. The term “enra” is a small basket weaved from the coconut leaves, and often used by Marshallese as a plate to share and distribute food amongst each other. Bwe-jen-lale-rara is about noticing and providing for the needs of others, and “enra” the basket will help support and provide for all that are in need. “Enra-bwe-jen-lale-rara” is symbolic of cultural exchange and reciprocity and the cultural values associated with building and maintaining relationships, and constantly honouring each other. As a Marshallese practice, in this article we share our understanding and knowledge about the challenges as well as possible solutions for education concerns in our nation. In addition, we highlight another proverb, “wa kuk wa jimor”, which relates to having one canoe, and despite its capacity to feed and provide for the individual, but within the canoe all people can benefit from what it can provide. In the same way, we provide in this paper a cultural framework that will enable all educators to benefit from. It is a framework that is far-reaching and relevant to the lived realities of Marshallese people today. Kumit relates to people united to build strength, all co-operating and working together, living in peace, harmony, and good health. Kanne Lobal: conceptual framework for education and leadership An education framework is a conceptual structure that can be used to capture ideas and thinking related to aspects of learning. Kanne Lobal is conceptualised and framed in this paper as an educational framework. Kanne Lobal highlights the significance of education as a collective partnership whereby leadership is an important aspect. Kanne Lobal draws-from indigenous Marshallese concepts like kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness, heart). The role of a leader, including an education leader, is to prioritise collective learning and partnerships that benefits Marshallese people and the continuity and survival of the next generation (Heine, 2002; Thaman, 1995). As described by Ejnar Aerōk, an expert canoe builder in the RMI, he stated: “jerbal ippān doon bwe en maron maan wa e” (cited in Miller, 2010, p. 69). His description emphasises the significance of partnerships and working together when navigating and journeying together in order to move the canoe forward. The kubaak, the outrigger of the wa (canoe) is about “partnerships”. For us as elementary school leaders on Majuro, kubaak encourages us to value collaborative partnerships with each other as well as our communities, PSS, and other stakeholders. Partnerships is an important part of the Kanne Lobal education and leadership framework. It requires ongoing bwebwenato – the inspiring as well as confronting and challenging conversations that should be mediated and negotiated if we and our education stakeholders are to journey together to ensure that the educational services we provide benefits our next generation of young people in the RMI. Navigating ahead the partnerships, mediation, and negotiation are the core values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity). As an organic conceptual framework grounded in indigenous values, inspired through our lived experiences, Kanne Lobal provides ideas and concepts for re-thinking education and leadership practices that are conducive to learning and teaching in the schooling context in the RMI. By no means does it provide the solution to the education ills in our nation. However, we argue that Kanne Lobal is a more relevant approach which is much needed for the negatively stigmatised system as a consequence of the various colonial administrations that have and continue to shape and reframe our ideas about what education should be like for us in the RMI. Moreover, Kannel Lobal is our attempt to decolonize the framing of education and leadership, moving our bwebwenato to re-framing conversations of teaching and learning so that our cultural knowledge and values are foregrounded, appreciated, and realised within our education system. Bwebwenato: sharing our stories In this section, we use bwebwenato as a method of gathering and capturing our stories as data. Below we capture our stories and ongoing conversations about the richness in Marshallese cultural knowledge in the outer islands and on Majuro and the potentialities in Kanne Lobal. Danny Jim When I was in third grade (9-10 years of age), during my grandfather’s speech in Arno, an atoll near Majuro, during a time when a wa (canoe) was being blessed and ready to put the canoe into the ocean. My grandfather told me the canoe was a blessing for the family. “Without a canoe, a family cannot provide for them”, he said. The canoe allows for travelling between places to gather food and other sources to provide for the family. My grandfather’s stories about people’s roles within the canoe reminded me that everyone within the family has a responsibility to each other. Our women, mothers and daughters too have a significant responsibility in the journey, in fact, they hold us, care for us, and given strength to their husbands, brothers, and sons. The wise man or elder sits in the middle of the canoe, directing the young man who help to steer. The young man, he does all the work, directed by the older man. They take advice and seek the wisdom of the elder. In front of the canoe, a young boy is placed there and because of his strong and youthful vision, he is able to help the elder as well as the young man on the canoe. The story can be linked to the roles that school leaders, teachers, and students have in schooling. Without each person knowing intricately their role and responsibility, the sight and vision ahead for the collective aspirations of the school and the community is difficult to comprehend. For me, the canoe is symbolic of our educational journey within our education system. As the school leader, a central, trusted, and respected figure in the school, they provide support for teachers who are at the helm, pedagogically striving to provide for their students. For without strong direction from the school leaders and teachers at the helm, the students, like the young boy, cannot foresee their futures, or envisage how education can benefit them. This is why Kanne Lobal is a significant framework for us in the Marshall Islands because within the practice we are able to take heed and empower each other so that all benefit from the process. Kanne Lobal is linked to our culture, an essential part of who we are. We must rely on our own local approaches, rather than relying on others that are not relevant to what we know and how we live in today’s society. One of the things I can tell is that in Majuro, compared to the outer islands, it’s different. In the outer islands, parents bring children together and tell them legends and stories. The elders tell them about the legends and stories – the bwebwenato. Children from outer islands know a lot more about Marshallese legends compared to children from the Majuro atoll. They usually stay close to their parents, observe how to prepare food and all types of Marshallese skills. Loretta Joseph Case There is little Western influence in the outer islands. They grow up learning their own culture with their parents, not having tv. They are closely knit, making their own food, learning to weave. They use fire for cooking food. They are more connected because there are few of them, doing their own culture. For example, if they’re building a house, the ladies will come together and make food to take to the males that are building the house, encouraging them to keep on working - “jemjem maal” (sharpening tools i.e. axe, like encouraging workers to empower them). It’s when they bring food and entertainment. Rubon Rubon Togetherness, work together, sharing of food, these are important practices as a school leader. Jemjem maal – the whole village works together, men working and the women encourage them with food and entertainment. All the young children are involved in all of the cultural practices, cultural transmission is consistently part of their everyday life. These are stronger in the outer islands. Kanne Lobal has the potential to provide solutions using our own knowledge and practices. Connie Joel When new teachers become a teacher, they learn more about their culture in teaching. Teaching raises the question, who are we? A popular saying amongst our people, “Aelon kein ad ej aelon in manit”, means that “Our islands are cultural islands”. Therefore, when we are teaching, and managing the school, we must do this culturally. When we live and breathe, we must do this culturally. There is more socialising with family and extended family. Respect the elderly. When they’re doing things the ladies all get together, in groups and do it. Cut the breadfruit, and preserve the breadfruit and pandanus. They come together and do it. Same as fishing, building houses, building canoes. They use and speak the language often spoken by the older people. There are words that people in the outer islands use and understand language regularly applied by the elderly. Respect elderly and leaders more i.e., chiefs (iroj), commoners (alap), and the workers on the land (ri-jerbal) (social layer under the commoners). All the kids, they gather with their families, and go and visit the chiefs and alap, and take gifts from their land, first produce/food from the plantation (eojōk). Tommy Almet The people are more connected to the culture in the outer islands because they help one another. They don’t have to always buy things by themselves, everyone contributes to the occasion. For instance, for birthdays, boys go fishing, others contribute and all share with everyone. Kanne Lobal is a practice that can bring people together – leaders, teachers, stakeholders. We want our colleagues to keep strong and work together to fix problems like students and teachers’ absenteeism which is a big problem for us in schools. Demetria Malachi The culture in the outer islands are more accessible and exposed to children. In Majuro, there is a mixedness of cultures and knowledges, influenced by Western thinking and practices. Kanne Lobal is an idea that can enhance quality educational purposes for the RMI. We, the school leaders who did GCSL, we want to merge and use this idea because it will help benefit students’ learning and teachers’ teaching. Kanne Lobal will help students to learn and teachers to teach though traditional skills and knowledge. We want to revitalize our ways of life through teaching because it is slowly fading away. Also, we want to have our own Marshallese learning process because it is in our own language making it easier to use and understand. Essentially, we want to proudly use our own ways of teaching from our ancestors showing the appreciation and blessings given to us. Way Forward To think of ways forward is about reflecting on the past and current learnings. Instead of a traditional discussion within a research publication, we have opted to continue our bwebwenato by sharing what we have learnt through the Graduate Certificate in School Leadership (GCSL) programme. Our bwebwenato does not end in this article and this opportunity to collaborate and partner together in this piece of writing has been a meaningful experience to conceptualise and unpack the Kanne Lobal framework. Our collaborative bwebwenato has enabled us to dig deep into our own wise knowledges for guidance through mediating and negotiating the challenges in education and leadership (Sanga & Houma, 2004). For example, bwe-jen-lale-rara reminds us to inquire, pay attention, and focus on supporting the needs of others. Through enra-bwe-jen-lale-rara, it reminds us to value cultural exchange and reciprocity which will strengthen the development and maintaining of relationships based on ways we continue to honour each other (Nimmer, 2017). We not only continue to support each other, but also help mentor the next generation of school leaders within our education system (Heine, 2002). Education and leadership are all about collaborative partnerships (Sanga & Chu, 2009; Thaman, 1997). Developing partnerships through the GCSL was useful learning for us. It encouraged us to work together, share knowledge, respect each other, and be kind. The values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity) are meaningful in being and becoming and educational leader in the RMI (Jetnil-Kijiner, 2014; Miller, 2010; Nimmer, 2017). These values are meaningful for us practice particularly given the drive by PSS for schools to become accredited. The workshops and meetings delivered during the GCSL in the RMI from 2018 to 2019 about Kanne Lobal has given us strength to share our stories and experiences from the meeting with the stakeholders. But before we met with the stakeholders, we were encouraged to share and speak in our language within our courses: EDP05 (Professional Development and Learning), EDP06 (School Leadership), EDP07 (School Management), EDP08 (Teaching and Learning), and EDP09 (Community Partnerships). In groups, we shared our presentations with our peers, the 15 school leaders in the GCSL programme. We also invited USP RMI staff. They liked the way we presented Kannel Lobal. They provided us with feedback, for example: how the use of the sail on the canoe, the parts and their functions can be conceptualised in education and how they are related to the way that we teach our own young people. Engaging stakeholders in the conceptualisation and design stages of Kanne Lobal strengthened our understanding of leadership and collaborative partnerships. Based on various meetings with the RMI Pacific Resources for Education and Learning (PREL) team, PSS general assembly, teachers from the outer islands, and the PSS executive committee, we were able to share and receive feedback on the Kanne Lobal framework. The coordinators of the PREL programme in the RMI were excited by the possibilities around using Kanne Lobal, as a way to teach culture in an inspirational way to Marshallese students. Our Marshallese knowledge, particularly through the proverbial meaning of Kanne Lobal provided so much inspiration and insight for the groups during the presentation which gave us hope and confidence to develop the framework. Kanne Lobal is an organic and indigenous approach, grounded in Marshallese ways of doing things (Heine, 2002; Taafaki & Fowler, 2019). Given the persistent presence of colonial processes within the education system and the constant reference to practices and initiatives from the US, Kanne Lobal for us provides a refreshing yet fulfilling experience and makes us feel warm inside because it is something that belongs to all Marshallese people. Conclusion Marshallese indigenous knowledge and practices provide meaningful educational and leadership understanding and learnings. They ignite, inspire, and transform thinking and practice. The Kanne Lobal conceptual framework emphasises key concepts and values necessary for collaborative partnerships within education and leadership practices in the RMI. The bwebwenato or talk stories have been insightful and have highlighted the strengths and benefits that our Marshallese ideas and practices possess when looking for appropriate and relevant ways to understand education and leadership. Acknowledgements We want to acknowledge our GCSL cohort of school leaders who have supported us in the development of Kanne Lobal as a conceptual framework. A huge kommol tata to our friends: Joana, Rosana, Loretta, Jellan, Alvin, Ellice, Rolando, Stephen, and Alan. References Benson, C. (2002). Preface. In F. Pene, A. M. Taufe’ulungaki, & C. Benson (Eds.), Tree of Opportunity: re-thinking Pacific Education (p. iv). Suva, Fiji: University of the South Pacific, Institute of Education. Bessarab, D., Ng’andu, B. (2010). Yarning about yarning as a legitimate method in indigenous research. International Journal of Critical Indigenous Studies, 3(1), 37-50. Fa’avae, D., Jones, A., & Manu’atu, L. (2016). Talanoa’i ‘a e talanoa - talking about talanoa: Some dilemmas of a novice researcher. AlterNative: An Indigenous Journal of Indigenous Peoples,12(2),138-150. Heine, H. C. (2002). A Marshall Islands perspective. In F. Pene, A. M. Taufe’ulungaki, & C. Benson (Eds.), Tree of Opportunity: re-thinking Pacific Education (pp. 84 – 90). Suva, Fiji: University of the South Pacific, Institute of Education. Infoplease Staff (2017, February 28). Marshall Islands, retrieved from https://www.infoplease.com/world/countries/marshall-islands Jetnil-Kijiner, K. (2014). Iep Jaltok: A history of Marshallese literature. (Unpublished masters’ thesis). Honolulu, HW: University of Hawaii. Kabua, J. B. (2004). We are the land, the land is us: The moral responsibility of our education and sustainability. In A.L. Loeak, V.C. Kiluwe and L. Crowl (Eds.), Life in the Republic of the Marshall Islands, pp. 180 – 191. Suva, Fiji: University of the South Pacific. Kupferman, D. (2004). Jelalokjen in flux: Pitfalls and prospects of contextualising teacher training programmes in the Marshall Islands. Directions: Journal of Educational Studies, 26(1), 42 – 54. http://directions.usp.ac.fj/collect/direct/index/assoc/D1175062.dir/doc.pdf Miller, R. L. (2010). Wa kuk wa jimor: Outrigger canoes, social change, and modern life in the Marshall Islands (Unpublished masters’ thesis). Honolulu, HW: University of Hawaii. Nabobo-Baba, U. (2008). Decolonising framings in Pacific research: Indigenous Fijian vanua research framework as an organic response. AlterNative: An Indigenous Journal of Indigenous Peoples, 4(2), 141-154. Nimmer, N. E. (2017). Documenting a Marshallese indigenous learning framework (Unpublished doctoral thesis). Honolulu, HW: University of Hawaii. Sanga, K., & Houma, S. (2004). Solomon Islands principalship: Roles perceived, performed, preferred, and expected. Directions: Journal of Educational Studies, 26(1), 55-69. Sanga, K., & Chu, C. (2009). Introduction. In K. Sanga & C. Chu (Eds.), Living and Leaving a Legacy of Hope: Stories by New Generation Pacific Leaders (pp. 10-12). NZ: He Parekereke & Victoria University of Wellington. Suaalii-Sauni, T., & Fulu-Aiolupotea, S. M. (2014). Decolonising Pacific research, building Pacific research communities, and developing Pacific research tools: The case of the talanoa and the faafaletui in Samoa. Asia Pacific Viewpoint, 55(3), 331-344. Taafaki, I., & Fowler, M. K. (2019). Clothing mats of the Marshall Islands: The history, the culture, and the weavers. US: Kindle Direct. Taufe’ulungaki, A. M. (2014). Look back to look forward: A reflective Pacific journey. In M. ‘Otunuku, U. Nabobo-Baba, S. Johansson Fua (Eds.), Of Waves, Winds, and Wonderful Things: A Decade of Rethinking Pacific Education (pp. 1-15). Fiji: USP Press. Thaman, K. H. (1995). Concepts of learning, knowledge and wisdom in Tonga, and their relevance to modern education. Prospects, 25(4), 723-733. Thaman, K. H. (1997). Reclaiming a place: Towards a Pacific concept of education for cultural development. The Journal of the Polynesian Society, 106(2), 119-130. Thiong’o, N. W. (1986). Decolonising the mind: The politics of language in African literature. Kenya: East African Educational Publishers. Vaioleti, T. (2006). Talanoa research methodology: A developing position on Pacific research. Waikato Journal of Education, 12, 21-34. Walsh, J. M., Heine, H. C., Bigler, C. M., & Stege, M. (2012). Etto nan raan kein: A Marshall Islands history (First Edition). China: Bess Press.

Purpose The World Health Organisation found depression to be the fourth leading cause of disability in Malawi (Bowie, 2006) with the prevalence of mental health need in children and young people in Malawi estimated between 10 and 30% (Kutcher et al., 2019). One option to address this was to provide schoolteachers with skills and knowledge related to mental health so they can better support children. There is generally a lack of evidence of the utility or feasibility of school-based mental health literacy programmes in low to medium income countries (LMIC). This paper aims to report on a project to train schoolteachers in Malawi on aspects of mental health. Design/methodology/approach The aim of this project was to determine the acceptability and feasibility of delivering a training initiative in Malawi to teachers to better enable them to recognise and cope with school children who had been exposed to trauma and substance misuse. Findings Feedback was generated through the use of a specifically designed pre and post measure, focus groups, interviews and observations of the teaching delivery. Practical implications Teachers found the training built on their existing knowledge and they requested further opportunities for training and consultation about how to manage difficult presentations. It was evident that teachers did not know how to access mental health care or support for children whose needs could not be met by schoolteachers alone. Originality/value For a sustainable improvement for children’s mental health care in this context, further training becomes valuable when located as part of a network of joined up health and educational services.

Abstract Background Diabetes Self-Management Education and Support (DSMES) programmes are vital for type 2 diabetes mellitus (T2DM) management. However, they are limited in Sub-Saharan Africa (SSA). To address this gap, a DSMES, namedEXTEND was developed in Lilongwe (Malawi) and Maputo (Mozambique). This qualitative study aimed to explore factors that influence the implementation of DSMES in these settings. Methods The Socio-ecological model was applied to explore factors influencing the implementation of DSMES in SSA. Data was analysed using the Framework method and constant comparative techniques. Sixty-six people participated in the study: people with T2DM who participated in the EXTEND programme; healthcare professionals (HCPs), EXTEND educators, EXTEND trainers, and stakeholders. Results Our findings indicate that there is a need to develop an integrated and dedicated diabetes services in SSA healthcare systems, incorporating culturally adapted DSMES and tailored diabetes training to all professions involved in diabetes management. Traditional media and the involvement of community leaders were proposed as important elements to help engage and promote DSMES programmes in local communities. During the design and implementation of DSMES, it is important to consider individual and societal barriers to self-care. Conclusion Findings from this study suggest that multi-faceted factors play a significant role to the implementation of DSMES programmes in LICs. In the future, EXTEND could be incorporated in the development of diabetes training and dedicated diabetes services in SSA healthcare systems, acting as an educational tool for both people with T2DM and HCPs. This project was supported by the Medical Research Council GCRF NCDs Foundation Awards 2016 Development Pathway Funding.

Abstract Background House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi. Methods In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored. Results The total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered. Conclusions In the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known. Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493