The Paris Agreement's success depends on parties' implementation of their Nationally Determined Contributions (NDCs) towards the Paris Agreement's goals. In these climate action plans, most developing countries make their mitigation and adaptation contributions conditional upon receiving international support (finance, technology transfer and/or capacity building). While provision of support for NDC implementation could enhance equity among countries, the feasibility of NDC implementation might be challenged by the large number of conditional NDCs. This paper addresses the implications of this tension based on an analysis of all 168 NDCs. We find that feasibility is challenged because conditions applied to NDCs are often not well defined. Moreover, the costs of implementing all conditional contributions are too high to be covered by existing promises of support from developed countries, even if the entire annual $100 billion of climate finance were earmarked for NDC implementation. Consistent with principles of equity and the prioritization in the Paris Agreement, a higher proportion of Least Developed Countries (LDCs) and Small Island Developing States (SIDS) have conditional NDCs than do other countries. However, differences between the distribution of countries requesting support and those currently receiving support, in particular among middle-income countries, demonstrates potential tensions between feasibility and equity. The article concludes with recommendations on how cost estimates and updated NDCs can be strengthened to ensure support for NDC implementation is targeted more equitably and cost-effectively. Key policy insights. Support requested by developing countries to implement conditional NDCs far exceeds existing funding pledges.. Differences between existing patterns of financial assistance, and those implied by requests under conditional NDCs, mean that supporting NDCs may require a significant shift in provider countries' priorities for allocating climate finance. This may challenge feasibility.. The Paris Agreement's provisions on prioritizing LDCs and SIDS offer valuable guidance in making difficult choices on allocating support.. To increase the likelihood of attracting support, developing countries (assisted by capacity building as needed), should include credible cost estimates in future NDCs and formulate investment plans.. By outlining plans to mobilize support in their NDCs, developed countries can reassure developing countries that raising the ambition of NDCs is feasible.
Background: Few studies have explicitly examined the implementation of change interventions in low- and middle-income country (LMIC) public health services. We contribute to implementation science by analyzing the implementation of an organizational change intervention in a large, hierarchical and bureaucratic public service in a LMIC health system. Methods: Using qualitative methods, we critically interrogate the implementation of an intervention to improve quality of obstetric and newborn services across 692 facilities in Uttar Pradesh and Bihar states of India to reveal how to go about making change happen in LMIC public health services. Results: We found that focusing the interventions on a discreet part of the health service (labour rooms) ensured minimal disruption of the status quo and created room for initiating change. Establishing and maintaining respectful, trusting relationships is critical, and it takes time and much effort to cultivate such relationships. Investing in doing so allows one to create a safe space for change; it helps thaw entrenched practices, behaviours and attitudes, thereby creating opportunities for change. Those at the frontline of change processes need to be enabled and supported to: lead by example, model and embody desirable behaviours, be empathetic and humble, and make the change process a positive and meaningful experience for all involved. They need discretionary space to tailor activities to local contexts and need support from higher levels of the organisation to exercise discretion. Conclusions: We conclude that making change happen in LMIC public health services, is possible, and is best approached as a flexible, incremental, localised, learning process. Smaller change interventions targeting discreet parts of the public health services, if appropriately contextualised, can set the stage for incremental system wide changes and improvements to be initiated. To succeed, change initiatives need to cultivate and foster support across all levels of the organisation.
Aims: To explore perceptions and determinants influencing alcohol consumption, with a view to inform development of suitable policies to control alcohol consumption.Methodology: Focus group discussions (FGDs) (n=24) were conducted in two Indian states among the rural Haryana (n=8 FGDs; 58 participants) and urban Delhi (n=16 FGDs; 113 participants) populations. Purposive sampling was used to recruit the participants, who were from high and low socioeconomic status (SES) groups and in the age group of 18-58 years.Results: Different factors influence alcohol consumption in high and low SES groups. The age of initiation is now as low as 10-12 years, attributable to the recent trend of increased accessibility. The participants agreed that alcohol consumption has now become a more acceptable part of daily living, whereas earlier it was limited to special occasions and festivals. This has contributed to an increase in drinking. Drinking among women was earlier a taboo, but now women (mainly of high SES), are often seen drinking at social gatherings. The respondents mentioned weak enforcement of regulatory policies related to alcohol consumption and sales.Conclusions: A shift in attitudes was observed towards drinking. Drinking is increasingly seen as a part of daily life. The availability of alcohol is perceived to be increasing and restrictions on sale are not effectively enforced. There is an urgent need to re-evaluate the alcohol policy from a public health perspective in India.
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