Using key informant monitoring in safe motherhood programming in Nepal

This article discusses the methodology and application of the Key Informant Monitoring (KIM) tool as used by the Nepal Safer Motherhood Project (NSMP). NSMP aims to achieve a sustained increase in the uptake of midwifery and essential obstetric care services by addressing, among other things, constraints on access to such services. Data collected by community-based Key Informant Researchers (KIRs) are synthesised and used by NSMP and key project partners for monitoring and planning purposes. NSMP has used KIM findings to modify its main interventions at the local level. International and Nepali NGOs have adopted KIM in their safe motherhood and other development programmes. Village Development Committees, with support from NGOs and NSMP, have responded to issues raised by KIM by running maternal health awareness-raising campaigns, working with traditional healers, improving the quality of care, and facilitating local emergency transport and funding schemes. KIRs have proved effective as sources of information and as change agents, spreading safe motherhood messages to promote behaviour change.     

By-elections,changing fortunes,uncertainty and the mid-term blues

If voters care about the size of the government's majority, then by-election votes should exaggerate national swings. Moreover, if there is uncertainty about the outcome of the general election and if voters” preferences are skewed in such a way as to give more weight to the “downside” outcome (least favourite party wins) than the “upside” (favoured party wins with a larger than preferred majority), then there will be a systematic tendency for governments to lose by-elections, regardless of any changes in national support. These predictions go beyond those generated by conventional explanations. The theory is successfully tested against data from 383 post-War elections.     

Latin American environmentalism: Comparative views

This article examines three common generalizations from the literature on Latin American environmentalism. The validity of these generalizations, structured as hypotheses, is tested with four case studies from Costa Rica, Mexico, Venezuela, and Brazil. The first generalization is that tensions arise between international environmentalists principally concerned with wildlands conservation and national environmentalists engaged in a broader array of local and domestic issues including urban environmental quality and access to natural resources. The second is that environmental groups in Latin America are elitist in structure and participant base. The third is that the particular tactics employed by environmentalists will be closely tied to the relative openness of their nation’s political system. Through a cross-disciplinary case study approach we find the first two hypotheses quickly break down upon closer inspection, while the third is supported. We suggest a modified framework for interpreting environmental activism in the region, one that weights the role of the state as well as the competing strategies employed by grassroots, private voluntary, and professionalized environmental groups. Latin American environmentalism is highly diverse, presenting many faces in different time periods and different countries. Developing one general theory of environmentalism in Latin America is impossible, but more specific categorizations of the middle range may be achievable.     

Reforming regulatory relationships: The impact of medical revalidation on doctors,employers, and the General Medical Council in the United Kingdom

In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation – a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi‐structured interviews with clinical and non‐clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors’ autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.     

Using Spaced Learning Principles to Translate Knowledge into Behavior: Evidence from Investigative Interviews of Alleged Child Abuse Victims

The present study assessed the progress of 13 investigative interviewers (child protection workers and police officers) before, during, and after an intensive training program (n = 132 interviews). Training began with a 2-day workshop covering the principles of child development and child-friendly interviewing. Interviewers then submitted interviews on a bi-weekly basis to which they received written and verbal feedback over an 8-month period. A refresher session took place two months into training. Interestingly, improvements were observed only after the refresher session. Interviews conducted post-refresher training contained proportionally more open-ended questions, more child details in response to open-ended questions, and proportionally fewer closed questions than interviews conducted prior to training and in the first half of the training program. The need for ‘spaced learning’ may underlie why so many training programs have had little effect on practice.