SARS-CoV-2 Transmission in Belgian French-Speaking Primary Schools: An Epidemiological Pilot Study.

Schools have been a point of attention during the pandemic, and their closure one of the mitigating measures taken. A better understanding of the dynamics of the transmission of SARS-CoV-2 in elementary education is essential to advise decisionmakers. We conducted an uncontrolled non-interventional prospective study in Belgian French-speaking schools to describe the role of attending asymptomatic children and school staff in the spread of COVID-19 and to estimate the transmission to others. Each participant from selected schools was tested for SARS-CoV-2 using a polymerase chain reaction (PCR) analysis on saliva sample, on a weekly basis, during six consecutive visits. In accordance with recommendations in force at the time, symptomatic individuals were excluded from school, but per the study protocol, being that participants were blinded to PCR results, asymptomatic participants were maintained at school. Among 11 selected schools, 932 pupils and 242 school staff were included between January and May 2021. Overall, 6449 saliva samples were collected, of which 44 came back positive. Most positive samples came from isolated cases. We observed that asymptomatic positive children remaining at school did not lead to increasing numbers of cases or clusters. However, we conducted our study during a period of low prevalence in Belgium. It would be interesting to conduct the same analysis during a high prevalence period.

Methodological approach and tools for systems thinking in health systems research: technical assistants' support of health administration reform in the Democratic Republic of Congo as an application.

In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.

[Change management: An analysis of actors; perceptions about technical assistance in the Democratic Republic of Congo]. / Accompagnement du changement : une analyse de représentations d’acteurs sur l’assistance technique en République Démocratique du Congo.

INTRODUCTION: Technical assistance (TA) is a common component of health system strengthening interventions. This type of intervention is too often designed and evaluated according to a logic that fails to take into account social complexity. Actors' perceptions are one element of this complexity. This article presents a study conducted in the Democratic Republic of Congo designed to identify perceptions concerning two types of technical support providers for health system strengthening: long-term technical assistants (agents of development agencies) and provincial technical advisors (agents of the Ministry of Health). METHODS: Interviews were conducted with an innovative tool inspired by the principles of systems thinking. Interviewees were actors involved in a TA intervention in the province of Bandundu. Their expectations regarding TA providers were identified in terms of personal characteristics (knowledge, know-how and interpersonal skills), roles, and styles of interaction for capacity building ("interventionist/ prescriptive axes"). RESULTS AND DISCUSSION: Interviewees emphasized the importance of mutual learning and the quality of interactions, which depends on TA provider's interpersonal skills and mutual willingness. Perceptions of TA provider's characteristics tend to be similar, but several differences were observed concerning the expectations about the roles of TAs, and the style that should be adopted for capacity building. Ignoring these differences in expectations may be a threat to the effectiveness of TA.

Referral hospitals in the Democratic Republic of Congo as complex adaptive systems: similar program, different dynamics.

INTRODUCTION: In many African countries, first referral hospitals received little attention from development agencies until recently. We report the evolution of two of them in an unstable region like Eastern Democratic Republic of Congo when receiving the support from development aid program. Specifically, we aimed at studying how actors' network and institutional framework evolved over time and what could matter the most when looking at their performance in such an environment. METHODS: We performed two cases studies between 2006 and 2010. We used multiple sources of data: reports to document events; health information system for hospital services production, and "key-informants" interviews to interpret the relation between interventions and services production. Our analysis was inspired from complex adaptive system theory. It started from the analysis of events implementation, to explore interaction process between the main agents in each hospital, and the consequence it could have on hospital health services production. This led to the development of new theoretical propositions. RESULTS: Two events implemented in the frame of the development aid program were identified by most of the key-informants interviewed as having the greatest impact on hospital performance: the development of a hospital plan and the performance based financing. They resulted in contrasting interaction process between the main agents between the two hospitals. Two groups of services production were reviewed: consultation at outpatient department and admissions, and surgery. The evolution of both groups of services production were different between both hospitals. CONCLUSION: By studying two first referral hospitals through the lens of a Complex Adaptive System, their performance in a context of development aid takes a different meaning. Success is not only measured through increased hospital production but through meaningful process of hospital agents'" network adaptation. Expected process is not necessarily a change; strengthened equilibrium and existing institutional arrangement may be a preferable result. Much more attention should be given in future international aid to the proper understanding of the hospital adaptation capacities.

Analyzing Katana referral hospital as a complex adaptive system: agents, interactions and adaptation to a changing environment.

This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in a changing environment that is affected for more than a decade by intermittent armed conflicts. His objective is to generate theoretical proposals for addressing differently the analysis of hospitals governance in the aims to assess their performance and how to improve that performance. The methodology applied approach uses a case study using mixed methods ( qualitative and quantitative) for data collection. It uses (1) hospital data to measure the output of hospitals, (2) literature review to identify among others, events and interventions recorded in the history of hospital during the study period and (3) information from individual interviews to validate the interpretation of the results of the previous two sources of data and understand the responsiveness of management team referral hospital during times of change. The study brings four theoretical propositions: (1) Interaction between key agents is a positive force driving adaptation if the actors share a same vision, (2) The strength of the interaction between agents is largely based on the nature of institutional arrangements, which in turn are shaped by the actors themselves, (3) The owner and the management team play a decisive role in the implementation of effective institutional arrangements and establishment of positive interactions between agents, (4) The analysis of recipient population's perception of health services provided allow to better tailor and adapt the health services offer to the population's needs and expectations. Research shows that it isn't enough just to provide support (financial and technical), to manage a hospital for operate and adapt to a changing environment but must still animate, considering that it is a complex adaptive system and that this animation is nothing other than the induction of a positive interaction between agents.

Aid effectiveness from Rome to Busan: some progress but lacking bottom-up approaches or behaviour changes.

The Busan partnership adopted at the 4th High Level Forum on Aid Effectiveness at the end of last year is a significant step forward towards the improvement of aid quality and the promotion of development. In particular, the inclusiveness achieved in Busan and the shift in discourse from 'aid effectiveness' to 'development effectiveness' are emblematic. However, key challenges still remain. Firstly, decision-making should be more bottom-up, finding ways to take into account the populations' needs and experiences and to enhance self-learning dynamics during the policy process. Today, it is particularly necessary to define what 'development' means at country level, according to the aspirations of particular categories of people and meeting operational and local expectations. Secondly, changes in language should be followed by a real change in mindset. Development stakeholders should further adapt their procedures to the reality of complex systems in which development interventions are being dealt with.