BackgroundVolunteer community health workers (CHWs) are an important link between the public health system and the community. The ‘Community Participation Policy for Health’ in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives.MethodsQualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres.ResultsFindings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers.ConclusionsThe fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.

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Knowledge of and Adherence to Health Advice among Adults with Diabetes in Libyahttp://researchonline.ljmu.ac.uk/id/eprint/2208/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Background: Non-adherence to medical and health care advice is a common problem, though reasons for non-adherence can differ across different groups and societies as well as between individuals. Objective: to examine diabetes knowledge among people with both type1 and type2 diabetes in Libya and explore any other factors that enhance adherence to treatment and management of the condition. Methods: A cross-sectional survey design was used to collect data from adults with type1 or type2 diabetes who have been diagnosed for 12 months or more, in Benghazi Diabetes Centre, which is one of the oldest and largest diabetes registries in Libya. A total of 855 participants were asked to fill in two questionnaires; the "Michigan Diabetes Knowledge Test" to investigate the level of diabetes knowledge and the Confidence in Diabetes Self-care Scale to assess self-efficacy. For the purpose of the study descriptive statistics and inferential statistical tests were conducted. Results: Diabetes knowledge is very poor especially among females and those classed as illiterate within the sample. The mean HbA 1c of 9.4 was higher than the recommended levels. Four variables namely knowledge about diabetes, duration of illness, family history and self-efficacy significantly predicted levels of HbA 1c . Conclusion: Based on the above findings, two different program of diabetes education would be recommended. The first would target those with inadequate levels of knowledge about diabetes, particularly women and people with long duration diabetes. The second would be for both healthcare professionals and people with type 1 and type 2 diabetes considering the psychological factors that are involved in diabetes management.

Background: Continuing professional development for nurses is internationally recognised as a key factor in improving quality of care, career progression, job satisfaction and professionalization. Meeting the global and national challenge of Universal Health Coverage will require a flexible and skilled workforce.  Since nurses are the backbone of health care in Nepal, their professional development is a key contribution to this task. Objective: To explore the views of senior nurses on the need and opportunities for continuing professional development in nursing in Nepal and current barriers to its development. Methods: Purposive sampling was used to identify participants and semi-structured interviews were conducted until saturation was reached. Interviews were transcribed verbatim and analysed using thematic analysis. 19 senior nurses, female (n=17) and male (n=2) working across the sector as clinicians, teachers and managers in Nepal participated in this study. Results: Analysis revealed several themes and subthemes, including: the conceptualisation of CPD in Nepal; provision and funding; barriers – fiscal, political and geographical challenges; and future priorities which included a discussion around basic skills versus advanced practice. Conclusions: The study provides an overview of opportunities and challenges for equitable access to continuing professional development in Nepal. Our findings illuminate the need for nurse leaders to work with policy makers and nursing organisations to establish the priorities for continuing development in light of increasing demand and expectations of health services.

Background: The need for a professionalized and highly skilled public health workforce is essential to improving and protecting the health of populations, especially in Nepal. This study aimed to explore: (i) the current trends in public health in Nepal and (ii) the opportunities and barriers to the professionalization of the sector. Methods: We employed an exploratory qualitative research design and used a combination of semi-structured interviews with senior public health professionals and a small focus group discussion with more recently qualified public health practitioners in Nepal. A total of nine professional stakeholders were interviewed and five junior practitioners joined the focus group discussion. Data was collected via Skype due to COVID-19 restrictions. Thematic analysis was used to analyze the data. Results: Four core themes emerged from the research: understanding the public health approach; health priorities; federalization and the impact on public health practice; professionalization and workforce development. Conclusions: Political federalization and more recently COVID-19 have impacted the development, capacity, and employment of this often-neglected workforce. Public health graduates with their broad-ranging knowledge and skills are often overlooked in the health sector. This is related to a general lack of understanding of what public health is and what public health practitioners do amongst politicians and the general public.

Background Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services. Methods A descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures. Results Out ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns. Conclusion HFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.

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This paper has in part emerged from work recently undertaken by Parker and Pant under a British Academy funded Small Grant examining the phenomenon of aging in Nepal. This has enabled them to work in collaboration with the Nepal School of Social Work in Kathmandu to both generate locally relevant empirical research on aging and to facilitate the creation of spaces for dialogue on the implications of aging in Nepal. As a result of this project a network of key academics, activists, government policy makers and non-government organizations, both national and international, has been formed. The findings of this study reveal a lack of both empirical data and theoretical development on aging in Nepal. Aging in the west is often viewed from a biomedical perspective where the emphasis is on medical treatment and health and social care arrangements. Biomedicine also dominates international health strategies, organizations, and the funding streams for aid, of which Nepal is a recipient. Whilst longevity is clearly a positive outcome of development, it also presents health and social care dilemmas. This paper provides an opportunity to explore some of these key issues and highlights the need for practitioners, policy makers and the research community in Nepal to provide an open dialogue in which local, culturally appropriate decisions can be developed in the best interest of older people in Nepal.