Eliminating again, for the last time: A case study of donor support for malaria in Solomon Islands.

Malaria elimination has been a recurring policy goal in Solomon Islands and has historically succeeded in attracting substantial donor support. Drawing on literature review and key informant interviews, we examine the influence of foreign aid on malaria control and elimination efforts in Solomon Islands between 2002 and 2016, as a unique case study of an Asia-Pacific country with high malaria burden and high donor funding. While aid appears to have contributed to reduced malaria prevalence, the ways in which aid was delivered in the short term had health systems impacts with implications for the elimination agenda. Key areas that will be critical to the future pursuit of malaria elimination in Solomon Islands include: integration of the vertical malaria program, while strengthening provincial-level service delivery; maximising incentives of performance-based financing modalities; and policy alignment between donors and domestic actors. We conclude by discussing principles exemplified in the case study of broader relevance to malaria-endemic countries.

Exploring the paradox: A cross-sectional study of academic dishonesty among Australian nursing students.

BACKGROUND: Universities' responsibility to ensure academic integrity is frustrated by software and communication tools that facilitate content reuse coupled with a growing international essay writing economy. A wide range of behaviours constitute academic dishonesty and while a complex phenomenon to examine, existing evidence suggests that there is sufficient proliferation (both in volume and variety) of these behaviours among Australian university students to warrant concern. This proliferation presents faculty and staff with new challenges in ensuring academic integrity. OBJECTIVES: This paper reports findings of a nationwide cross-sectional survey of 361 students enrolled in an Australian nursing degree program and describes the extent of academic dishonesty among those surveyed. DESIGN: An online survey adapted from previous work was used to collect data on academic dishonesty, professional dishonesty and social desirability bias. Analysis of this data enabled identification of the prevalence of dishonesty, relationships between individual characteristics and dishonest behaviours, associations between academic and professional dishonesty, and the impact of deterrents to such behaviour. RESULTS: Plagiarism was the most frequently reported form of academic misconduct. Most participants indicated that threat of severe punishment and signing of verification statements would deter undesirable academic behaviour. Despite this, a relatively high proportion of students reported engaging in at least one form of academic misconduct, the likelihood of which was higher among younger age groups. Of concern was that a correlation was found between academic and professional misconduct, the most common being the recording of inaccurate or fabricated vital signs and breaching client privacy. CONCLUSION: In health professional education, there is a tendency to assume that the nobility of these disciplines would result in a lower incidence of cheating behaviours. The findings of this study support existing literature that refutes this assumption. This study found troubling rates of academic and professional misconduct among the surveyed population.

Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

INTRODUCTION: Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia. METHODS: Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho) and ENRICH (Ethiopia). RESULTS: In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8%) or because participants were away from the pills (32.7%). In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%), participants not answering (27.3%), participants' discomfort speaking on the phone (15.4%), and network problems (13.2%). Structural, facility-level, participant-level, and data collection challenges were encountered in these settings. DISCUSSION: Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are provided with study phones and rigorously ensure that call attempts are made for these participants.

Perceptions of incentives offered in a community-based malaria diagnosis and treatment program in the Highlands of Papua New Guinea.

What motivates community-based health workers to provide care in rural and remote areas, often on a voluntary or casual basis, is a key question for program managers and public health officials. This paper examines how a range of incentives offered as part of the Marasin Stoa Kipa program, a community-based malaria diagnosis and treatment program that has been implemented since 2007 within a major oil and gas development area in Papua New Guinea, are perceived and critiqued by community-based health workers. Nineteen interviews and seven focus group discussions with the workers who deliver services and members of the communities served by the program, conducted between November 4 and 25, 2015, reveal a pattern of mixed motivations and changes in motivation over time. This can be attributed partly to the unique social and economic circumstances in which the program is operating. Changes in the burden of disease as well as in global and national health services policy with implications for local level program operations also had an impact, as did the nature of relationships between program managers, community-based health workers, and program beneficiaries. Overall, the findings suggest that while financial and in-kind incentives can be a useful tool to motivate voluntary or minimally-compensated community-based health workers, they must be carefully structured to align with local social, economic, and epidemiological realities over the long-term.

Gauging Change in Australian Aid: Stakeholder Perceptions of the Government Aid Program.

In this article, we use data from the 2013 and 2015 Australian Aid Stakeholder Surveys to gauge the extent of the changes to the Australian Government Aid Program since the 2013 federal election. The two surveys targeted the same set of stakeholders of the aid program, and both gathered data on a wide range of aspects of its functioning. As we assess the findings that emerged from the surveys, we situate our work amongst recent academic studies that have looked at the post-2013 aid changes in Australia. Our key findings are that the post-2013 changes to Australian aid have had wide-ranging impacts and have led to deteriorating overall aid quality. However, changes have not affected all aspects of the aid program equally, and some changes are starting to be reversed. In discussion, we examine what these developments mean for the future of Australian aid.

Making sense of HIV in southeastern Nigeria: fictional narratives, cultural meanings, and methodologies in medical anthropology.

Fictional narratives have rarely been used in medical anthropological research. This article illustrates the value of such narratives by examining how young people in southeastern Nigeria navigate the cultural resources available to them to make sense of HIV in their creative writing. Using thematic data analysis and narrative-based methodologies, it analyzes a sample (N = 120) from 1,849 narratives submitted by Nigerian youth to the 2005 Scenarios from Africa scriptwriting contest on the theme of HIV. The narratives are characterized by five salient themes: tragedy arising from the incompatibility of sex outside marriage and kinship obligations; female vulnerability and blame; peer pressure and moral ambivalence; conservative Christian sexual morality; and the social and family consequences of HIV. We consider the strengths and limitations of this narrative approach from a theoretical perspective and by juxtaposing our findings with those generated by Daniel Jordan Smith using standard ethnographic research methods with a similar Igbo youth population.