From scaling up to sustainability in HIV: potential lessons for moving forward.

BACKGROUND: In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need to assess what strategies and practices of scaling up are also relevant for sustaining delivery at scale. METHODS: We reviewed white and gray literature to identify domains central to scaling-up programs and reviewed HIV case studies to identify how these domains might relate to sustaining delivery at scale. RESULTS: We found 10 domains identified as important for successfully scaling up programs that have potential relevance for sustaining delivery at scale: fiscal support; political support; community involvement, integration, buy-in, and depth; partnerships; balancing flexibility/adaptability and standardization; supportive policy, regulatory, and legal environment; building and sustaining strong organizational capacity; transferring ownership; decentralization; and ongoing focus on sustainability. We identified one additional potential domain important for programs sustaining delivery at scale: emphasizing equity. CONCLUSIONS: Today, the public and private sector are examining their ability to generate value for populations. All stakeholders are aiming to stem the tide of the HIV epidemic. Implementers need a framework to guide the evolution of their strategies and management practices. Greater research is needed to refine the domains for policy and program implementers working to sustain HIV program delivery at scale.

Reducing the health effect of natural hazards in Bangladesh.

Bangladesh, with a population of 151 million people, is a country that is particularly prone to natural disasters: 26% of the population are affected by cyclones and 70% live in flood-prone regions. Mortality and morbidity from these events have fallen substantially in the past 50 years, partly because of improvements in disaster management. Thousands of cyclone shelters have been built and government and civil society have mobilised strategies to provide early warning and respond quickly. Increasingly, flood and cyclone interventions have leveraged community resilience, and general activities for poverty reduction have integrated disaster management. Furthermore, overall population health has improved greatly on the basis of successful public health activities, which has helped to mitigate the effect of natural disasters. Challenges to the maintenance and reduction of the effect of cyclones and floods include rapid urbanisation and the growing effect of global warming. Although the effects of earthquakes are unknown, some efforts to prepare for this type of event are underway.

Caregivers' perceptions of child mental health needs and service utilization: an urban 8-year old sample.

This study extended previous research on mental health utilization to a sample of 214 preadolescent children and their caregivers. Predictors of two distinct phases of service utilization were tentatively examined in multivariate analyses: caregivers' perceptions that children needed services and receipt of those services by children. Of these children, 24.8% were perceived by their caregivers as needing mental health services; 11.7% received mental health services and 13.1% did not. Internalizing behavioral problems increased children's likelihood of being seen as needing services, but failed to increase likelihood of receiving services. Four factors predicted receipt of mental health services: relative lack of poverty, non-African American ethnicity, externalizing behavior problems, and child history of maltreatment. Implications for services targeted at preadolescent children are discussed.