What Matters to Others: A High-Threshold Account of Joint Attention.

If only implicitly, social anthropology has long incorporated joint attention as a research technique employed in what anthropologists call "the field". This paper outlines the crucial role joint attention plays in anthropolgical fieldwork-specifically in Participant Observation-and advances the position that joint attention is a goal rather than a starting point of fieldwork practice. Exploring how anthropologists tentatively use attention as a methodological tool to understand other people's lifeworlds, this paper draws parallels between Participant Observation and ordinary everyday interactions, thus teasing out a view of joint attention as a goal to be reached only by means of knowing what matters to others in the context of the lifeworld they inhabit.

Beyond technology acceptance-a focused ethnography on the implementation, acceptance and use of new nursing technology in a German hospital.

Introduction: Hospitalised patients could benefit from the emergence of novel technologies for nursing care. There are numerous technical products available, but these rarely find their way into practice. Further knowledge is required about the circumstances under which technology in nursing is accepted and used. In the research project "Centre for Implementing Nursing Care Innovations", technical innovations are implemented on a trauma surgery inpatient ward in Germany. After implementation, it was investigated: Which implemented technologies are accepted/rejected, and which factors influence the acceptance/rejection of technology for nurses? Material and methods: A focused ethnography was used, containing two approaches: First, participant observation was conducted to examine nurses' and patients' interaction with technologies. Observations were fixed in a field research diary and analysed using evaluative qualitative content analysis. Second, a questionnaire was used by nurses to provide information about the use frequency and technology suitability. The results of the study were consolidated and analysed using the UTAUT model. Results: Seven studied technologies can be summarised in four result categories: (1) A Mobilising mattress, a Special projector and a Sound pillow are accepted and used by nurses and patients, because they offer a way to provide high quality care with little additional effort. (2) A Fall prevention system is consistently used in patient care as a work obligation, but since nurses consider the system error-prone, acceptance is low. (3) An Interactive therapy ball is accepted but nurses cannot use it due to the high workload. (4) An App for nurse-patient communication and a work-equipment tracking system are not used or accepted because nurses do not see a practical benefit in the systems. Discussion: Acceptance or rejection of a product does not necessarily equate to use or non-use of the technology. Before implementation, technology acceptance among users occurs as prejudice-when users are given time to experiment with technology, intention-to-use can stabilize into sustained use. Accepted and used technologies can serve to mask problems (such as staff shortages) and encourage problematic developments, such as the reduction of contact time at the bedside. Therefore, technology acceptance should be qualified in asking to what accepted technology contributes.

Experience of Transitional Care Among Thai-Isan Older Stroke Survivors and Their Family Caregivers.

The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger-Templin-Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period.

A picture of artisanal and small-scale gold mining (ASGM) in Brazil and its mercury emissions and releases.

This study presents a picture of ASGM in Brazil and prospective numbers on mercury emissions and releases in 2016, when the country declared production of about 90 tonnes of gold, of which circa 25 tonnes came from ASGM. However, it is also necessary to consider the illegal production of ASGM which is estimated to vary between 10% and eight times more than the legal production. The proposed method included: organization of spatial data on legal ASGM output, stakeholder identification and meetings, mercury metallurgical balance, quantitative measurement of mercury in the atmosphere and qualitative social aspects such as the miners' economic dependence on the managers and scenarios of illegal ASGM annual production. The main results revealed that the initial mercury (Hg)-gold (Au) production ratio was higher for the primary whole ore than for the concentrate secondary ore, which is the most frequent type of Brazilian ASGM. The amalgam filtering technique followed by mercury recovery is routine, decreasing the Hg releases to tailings ponds or to soil and water bodies. The mercury emissions by thermal decomposition of amalgam are independent of the initial mercury mass, depending only on the mercury in the amalgam and the (adequate) use or not of emission control systems. Illegal activities reduce the availability and proper use of these systems, resulting in higher emissions. Mercury emissions from ASGM in Brazil may increase the global mercury emissions estimates, while their mercury releases may represent a marginal increase. As the mercury emitted may be trapped by the rainforests added to the mercury released, the environmental contamination may pose health risks to Amazonian population, which requires immediate action.

Inside regular lab meetings: The social construction of a research team and ideas in optical physics.

Scheduled meetings are associated with standardization and understood as a bureaucratic form of coordination, control, and rule observation. In attending assemblies of a research team in optical physics for over a year, we found regular lab meetings are compulsory for all their members and are an avenue to announce and give information about new and changed institutional regulations, to supervise members' activities and their output. But more importantly, they offer an environment for continuous thinking through talk that goes beyond announcements. Meetings are a protected space to comment on conducted research, to amend experimental set-ups, to test argumentation, and to outline potentially new directions of research. By participating in these practices, researchers, become members of the team as they get acquainted with the ongoing research; its scope, problems, and limits; the solutions at hand; and the know-how within the team. In functional terms, observed internal meetings seem to (a) ensure that the research team focuses on a specific research agenda by talking about and discussing ongoing research in the lab, (b) be used to discuss and assure the quality of the team's research output, and (c) generate and inspire new research within the team. Our findings suggest regular internal meetings, like shop talk, are constitutive of doing science by talking about ongoing research.

Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study.

AIM: To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. DESIGN: We conducted a fieldwork study with triangulation of participant observation and individual interviews. METHODS: Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face-to-face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. FINDINGS: Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. CONCLUSION: Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. IMPLICATIONS FOR PATIENT CARE: Proactive and reactive symptom assessment of non-speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication. IMPACT: This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. REPORTING METHOD: We used the consolidated criteria for reporting qualitative research. PATIENT CONTRIBUTION: A user representative was involved in the design of the study.

Challenging dominant narratives, interrupting objectification, and queer creativity: Queer sex worker art in Los Angeles.

Drawing on queer of color critique, this paper uses mixed methods including participant observation, interviews, visual and textual analysis, and photovoice to interrogate sex workers' queer creative practices. Building upon the larger oeuvre of sex working artists, contemporary sex working artists in Los Angeles utilizes queer creativity to thwart hegemonic readings of sex work. Performances at two activist fundraisers drew on the themes and esthetics of sex work to counter mainstream narratives about sex work and workers, and to interrupt their objectification. The cover and graphics of a sex worker zine push back against dominant narratives about sex workers and the power structures that suppress sex worker self-representation. Photovoice methodology allowed sex workers to counteract objectification by telling their own stories. In their creative products, sex workers show how "queer" is a praxis of sex and gender disruption, rather than a simple identity category signaling non-heterosexuality, challenging homonormativity in addition to heteronormativity.

Blurred lines: Ethical challenges related to autonomy in home-based care.

BACKGROUND: Home-based care workers mainly work alone in the patient's home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. AIM: The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. RESEARCH DESIGN: The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. PARTICIPANTS AND RESEARCH CONTEXT: The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. ETHICAL CONSIDERATIONS: The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. FINDINGS: A main challenge was that staff found it difficult to respect the patient's autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff's threshold for considering the use of coercion appeared to be high. CONCLUSIONS: Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems.

The effectiveness of the use of a technology toolkit on activities and mother-child interactions: children with complex care needs.

PURPOSE: Meaningful interactions with significant others are crucial for children's well-being, including those with severe to profound intellectual and multiple disabilities. This study aimed to gain more insight into the potential of an ICT-Toolkit in enhancing or contributing to the interaction between parents and their children with complex care needs. METHODS: A multiple case study with an AB experimental design was conducted. Four mother-child dyads were observed during eight two-and-a-half-hour home visits. Children between 6 and 16 years with severe to profound intellectual and multiple disabilities were included. A participatory research observation approach was used. RESULTS: Using the ICT-Toolkit compared to the baseline phase stimulated a decrease in the repetitive activities of two of the four dyads. Overall, the activity repertoire of the children and the length of time being engaged in individual activities increased, and the activities together increased in three of the dyads. There were more turn-taking interactions; the children took more initiative to engage their mother in their activity, and the children exhibited more affection when engaging with the ICT-Toolkit items. Three mothers followed their children more in their play, and all mothers were more verbally and physically active in instructing and/or motivating their children. DISCUSSION: All mothers noticed their child's "new" behaviour when interacting with an ICT-Toolkit item. The mothers followed the child's lead when engaged with the ICT-Toolkit. The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect.

A technology toolkit contributes to activities and mother-child interactions for children with intensive care needs.The ICT-Toolkit contributes to more turn-taking interactions and more initiative taking by the children to engage their mother in their activity.Children exhibited more affection towards their mothers when engaging with the ICT-Toolkit items.The participation in this study led mothers of children with intensive care needs to mentalise about the needs of their child and how their behaviour may influence the behaviour of their child.The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect.

Forming Nursing Home Practices That Support Quality of Care for Residents. A Qualitative Observational Study.

Background: Residents of nursing homes are increasingly frail and dependent. At the same time, there are increased demands for quality of care and social life for individual residents. In this article, we explore how care workers contribute to quality of care and social life in shared living rooms in nursing homes. Methods: An ethnographically inspired design was applied, and a purposive sample of six units for long-term care in three nursing homes in Norway was included in the study. Data were collected by participant observation, including informal conversations with the staff and residents, and the data were analyzed using thematic analysis. Results: The analysis identified three main themes: working within the given context, creating care practices and organizing activities. The empirical findings demonstrate that care work focuses on meeting both the residents' physical and social needs and aiming for high-quality care and social life for the residents in nursing homes. Conclusion: The results of this study illustrate that nursing home practices are focused on residents as a group. However, care workers take advantage of personal skills and resources to work towards person-centred care within the given context. The quality of care is recognized in terms of how care workers meet individual residents' needs. The quality of care seems highly related to the capability and skills of individual care workers.

The meaning and impact on well-being of bespoke dancing sessions for those living with Parkinson's.

PURPOSE: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. METHODS: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. RESULTS: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. CONCLUSIONS: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool.

What is ethnographic about digital ethnography? A sociological perspective.

When COVID-19 health guidelines vastly restricted or shut down in-person ethnographic research in 2020, many researchers pivoted to forms of online qualitative research using platforms such as WeChat, Twitter, and Discord. This growing body of qualitative internet research in sociology is often encapsulated under the umbrella term "digital ethnography." But the question of what makes digital qualitative research ethnographic remains open. In this article, we posit that digital ethnographic research necessitates a negotiation of the ethnographer's self-presentation and co-presence within the field that other forms of qualitative research, such as content or discourse analysis, do not require to satisfy their epistemological stance. To make our case, we provide a brief overview of digital research in sociology and related disciplines. Then, we draw upon our experiences conducting ethnographies in digital communities and in-person communities (what we call here, "analog ethnography") to explore how decisions about self-presentation and co-presence facilitate or block the generation of meaningful ethnographic data. We think through pertinent questions such as: Does the lower barrier for anonymity online justify disguised research? Does anonymity generate thicker data? How should digital ethnographers participate in research environments? What are the possible repercussions of digital participation? We argue that digital and analog ethnographies share a common epistemology that is distinct from non-participatory forms of qualitative digital research-namely the need for the researcher to relationally gather data from the field site over an extended period of time.

Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units: A non-participant observation study.

National mental health policies accentuate the importance of having positive attitudes, skills, and knowledge among mental health professionals to facilitate recovery-oriented practices in all areas of mental health care. However, evidence suggests that mental health professionals' negative attitudes towards mental illness are still evident and that recovery-oriented practice in acute inpatient units may be poorly implemented. At the same time, there is also a paucity of research to understand Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice specifically. Therefore, this non-participant observation study aimed to explore Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient units by observing the interactions between the consumers and nurses. The Mental Illness Clinicians Attitudes Scale-v4 and The Recovery Attitudes Questionnaire inspired the development of a non-participant observation chart for this study and the observations were recorded on the chart. Six observations were conducted in three acute inpatient units. Observations focused on Mental Health Nurses' knowledge about mental illness, communication, dignity, respect, anxiety, fear, punishment, facilitation of real choices for consumers, physical care, cooperation with consumers' families and others and recovery orientation. Interpretive descriptive analysis was used to analyse the data. The results show that Mental Health Nurses generally have positive attitudes towards mental illness and recovery-oriented practice. Some deficits in the physical care of people with mental illness in the acute inpatient units were observed. Therefore, future research could address the adequate preparation of Mental Health Nurses to provide physical care to people with mental illnesses.

[Inter- and Transdisciplinarity as a Normative Dynamic: Challenges and Opportunities for Political Science]. / Inter- und Transdisziplinarität als normative Dynamik: Herausforderungen und Chancen für die Politikwissenschaft.

Inter- and transdisciplinarity (ITD) has been part of political science for quite some time now, but although political science regularly deals with its self-understanding, the consequences for research and researchers of ITD have not yet been systematically considered. To stimulate this debate, we conceptualize ITD as a spectrum of knowledge integration, application, and participation. We use International Relations norm research as a theoretical framework to describe, analyze, and reflect on ITD as a normative dynamic. Autoethnographically and through participatory observation, we examine ITD as a normative dynamic, with insights from three research projects in the field of sustainability. Specifically, we ask what implications ITD has for researchers and research in political science. As a result, we find that ITD offers both opportunities and challenges. In the context of knowledge integration, we discuss the importance of the participation of political science in major societal issues in contrast to ITD's preferences for a particular understanding of knowledge and research. We reflect on ITD's application bias in terms of problem-solving opportunities and output orientation. In addition, we consider the participation postulate of ITD and weigh potential democratizing effects against the conditions under which these might be realized. Finally, we address where further research seems useful to continue reflection on ITD.

Exploring the roles and challenges of the servant leadership: A critical examination of the Bangladesh police.

The police work relentlessly to control national, transnational, and economic cybercrimes despite the numerous internal, external, mental, physical, political, and social problems they face. This study attempted to assess the servant leadership (SL) roles of the police and the challenges they face with regard to SL practice. Using a self-directed survey questionnaire, the current study collected open-ended responses from 88 Bangladesh Police (BP) personnel ranking from Assistant Superintendent of Police to Additional Deputy Inspector General. The authors identified the SL roles of police, such as terrorism control, judicial assistance, empowering subordinates, engaging the community, police-media relationship, and contributing to the national economy. Besides, the participant observation method was used to explore several challenges that the police face in regard to SL practice, such as long working hours, inadequate logistical support, work stress, insufficient compensation package, and unfair promotion & performance appraisal system. This study recommended increasing cooperation among top and bottom-line police, including bottom-line police in decision-making authority, providing adequate logistic support and training and development opportunities to the police personnel, and ensuring fair promotion and performance appraisal system for the police.

Perceived benefits from peer-support among family caregivers of people with amyotrophic lateral sclerosis and cognitive impairments in a palliative rehabilitation blended online learning programme.

RATIONALE: Family caregivers of persons with amyotrophic lateral sclerosis and cognitive and/or behavioural impairments (PALS/CIs) experience various challenges and needs, including emotional and practical support from peers. Various forms of peer-support have shown different strengths and weaknesses; however, little is known about how family caregivers of PALS/CIs interact with and perceive virtual face-to-face peer-support. AIMS AND OBJECTIVES: The aim of this study was to understand how caregivers of PALS/CIs interact with and perceive virtual face-to-face peer-support in a palliative rehabilitation programme designed to promote targeted palliative rehabilitation initiatives for caregivers of PALS/CIs. METHOD: A qualitative design using participant observations of 17 recorded virtual group-facilitated meetings from two rounds of a 4-month intervention was performed. The Medical Research Council framework, the inductive interpretive description methodology and the theoretical framework of Sense of Coherence guided the study. Nineteen participants, divided into four groups, were included. RESULTS: Three themes emerged: 'Relating my situation to others', 'Making room for forbidden thoughts' and 'Longing for normalcy'. The themes reflected the various ways participants interacted in online group meetings and how the interactions evolved around practical, emotional and forbidden thoughts. Sharing personal and sorrowful concerns and frustrations engendered feelings of trust and a sense of belonging, which empowered the participants to address their genuine wish and longing for normalcy with all the trivialities of which ALS/CIs had robbed them. CONCLUSION: Virtual face-to-face peer-support can enable caregivers of PALS/CIs to share experiences of everyday life challenges that cannot always be shared elsewhere. Being able to relate to and learn from other's experiences alleviated feelings of loneliness, frustration, and concerns and thereby enhanced comprehensibility, manageability and meaningfulness. Online palliative rehabilitation interventions should provide an opportunity for caregivers to meet regularly in interactive group meetings. Familiarization takes time online and is necessary to improve their sense of feeling safe to share their deepest thoughts. Such group interventions, facilitated by trained healthcare professionals, offer a means to support dynamic group interactions and discussion of sensitive topics.

Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations.

BACKGROUND: Communication in the intensive care unit is challenged by patients' inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques. OBJECTIVES: The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges. METHODS: This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel. FINDINGS: Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise. CONCLUSIONS: This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.

How nurses use National Early Warning Score and Individual Early Warning Score to support their patient risk assessment practice: A fieldwork study.

AIM: To explore and describe how the National Early Warning Score (NEWS) and Individual Early Warning Score (I-EWS) are used and how they support nurses' patient risk assessment practice. DESIGN: A qualitative observational fieldwork study drawing on ethnographical principles was performed in six hospitals in two regions of Denmark in 2019. METHODS: Data were generated from participant observations and informal interviews with 32 nurses across 15 different wards in the hospitals. A total of 180 h of participant observation was performed. The observations lasted between 1.5 and 8 h and were conducted during day or evening shifts. RESULTS: NEWS and I-EWS supported nurses' observations of patients, providing useful knowledge for planning patient care, and prompting critical thinking. However, the risk assessment task was sometimes delegated to less experienced staff members, such as nursing students and healthcare assistants. The Early Warning Score (EWS) systems were often adapted by nurses according to contextual aspects, such as the culture of the speciality in which the nurses worked and their levels of competency. In some situations, I-EWS had the effect of enhancing nurse autonomy and responsibility for decision-making in relation to patient care. CONCLUSIONS: EWS systems support nurses' patient risk assessment practice, providing useful information. I-EWS makes it easier to factor the heterogeneity of patients and the clinical situation into the risk assessments. The delegation of risk assessment to other, less experienced staff members pose a risk to patient safety, which needs to be addressed in the ongoing debate regarding the shortage of nurses. IMPACT: The findings of this study can help ward nurses, hospital managers and policymakers to develop and improve strategies for improved person-centred nursing care.

Governance in primary care systems: Experiences and lessons from urban, rural, and remote settings in the Philippines

Methods@#Data on governance issues were obtained from participant observation and regular meetings facilitated over one year. Conducted across urban, rural, and remote settings, the present study outlines experience-near insights throughout a hierarchy of system implementers—from those in positions of authority to frontline workers. These insights were thematically analyzed and organized following the Health System Dynamics Framework.@*Results@#This study identified six governance challenges: 1) establishing a health information system; 2) engaging leaders, healthcare staff, and communities; 3) assuring efficient financing; 4) assuring health workforce sufficiency; 5) addressing legal challenges; and 6) planning evaluation and monitoring. To address these challenges, this study forwards systemic solutions to advance effective governance and improve healthcare performance.@*Conclusion@#A renewed approach to strengthening primary care systems is fundamental to achieving universal healthcare. This entails good governance that develops strategies, equips people with tools for proper implementation, and provides data for evidence-based policies. The experiences outlined in the present study envisions guiding policymakers toward improving health outcomes in a devolved setting.