Lessons from a successful national sanitation programme: the case of Nyumba ni Choo in Tanzania

Universal access to hygienic sanitation is a Sustainable Development Goal for international development. However, many countries are liable to miss this target by the deadline of 2030. As provision and subsidy are prohibitively expensive, promotion is the tactic commonly taken by governments and stakeholders in many countries, even though it is often not effective at generating significant changes in sanitation coverage. A recent 5-year programme used an international consortium made up of organizations' experts in consumer research, creative communication, programme management and event implementation, media monitoring and programme evaluation, to achieve significant increases in the coverage of improved sanitation facilities throughout Tanzania, using adaptive programming. A number of lessons, outlined here, can be drawn from this experience which are likely to be applicable to promotion efforts in other countries and contexts and which can hopefully help countries to reach their sanitation targets. These lessons include the use of motivation and targeted expertise rather than reliance on training, the use of the theory of change to guide development processes, targeting of high-level government support, collaboration with private sector actors, testing and refreshing of messaging, continuous monitoring of on-ground conditions, use of multiple modes of outreach and branding of all programme outputs.

Considerations for Monitoring School Health and Nutrition Programs

School health and nutrition (SHN) interventions are among the most ubiquitous public health investments and comprise a key mechanism for reaching populations that are otherwise difficult to reach through the health system. Despite the critical role of monitoring these multisectoral programs to enable data-informed adaptive programming, information to guide program implementers is scant. This manuscript provides an overview of how monitoring indicators can be selected across a SHN program's logical framework, with specific examples across five SHN implementation models. Adaptation of SHN programs in times of school closures, such as those currently being experienced globally due to the emergence of COVID-19, is also addressed. Key aspects of SHN program monitoring are explored, including: (1) why monitor; (2) what to measure; (3) how to measure; and (4) who measures. In situations of school closures, strategies to shift both program activities and corresponding monitoring mechanisms are critical to understanding the rapidly evolving situation and subsequently guiding policy actions to protect vulnerable populations.

IDENTIFYING PREDICTORS OF SUBSTANCE USE AND RECIDIVISM OUTCOME TRAJECTORIES AMONG DRUG TREATMENT COURT CLIENTS

Drug treatment court (DTC) is a diversion program for individuals with drug-related crimes. However, the DTC literature is conflicting with regard to substance use and recidivism outcomes. This study examines factors associated with improved client outcome trajectories among a multisite, national DTC sample. We conducted a secondary analysis of 2,295 participants using the Global Appraisal of Individual Needs assessment tool. Participants in community-based treatment comprised a nonequivalent comparison group. Zero-inflated Poisson (ZIP) regression examined client sociodemographics in relation to substance use and rearrest at 6-month follow-up. Employed DTC clients were more likely to abstain from substances, but among all study participants, higher baseline use, male gender, and employment predicted substance use. Similarly, among DTC clients, older age and employment predicted no rearrests, but among all study participants, older and employed individuals had worse arrest outcome trajectories. Future work is needed to better understand how client characteristics may inform individualized treatment approaches.

An Experimental Trial of Adaptive Programming in Drug Court: Outcomes at 6, 12 and 18 Months

OBJECTIVES

Test whether an adaptive program improves outcomes in drug court by adjusting the schedule of court hearings and clinical case-management sessions pursuant to a priori performance criteria.

METHODS

Consenting participants in a misdemeanor drug court were randomly assigned to the adaptive program (n = 62) or to a baseline-matching condition (n = 63) in which they attended court hearings based on the results of a criminal risk assessment. Outcome measures were re-arrest rates at 18 months post-entry to the drug court and urine drug test results and structured interview results at 6 and 12 months post-entry.

RESULTS

Although previously published analyses revealed significantly fewer positive drug tests for participants in the adaptive condition during the first 18 weeks of drug court, current analyses indicate the effects converged during the ensuing year. Between-group differences in new arrest rates, urine drug test results and self-reported psychosocial problems were small and non-statistically significant at 6, 12 and 18 months post-entry. A non-significant trend (p = .10) suggests there may have been a small residual impact (Cramer's ν = .15) on new misdemeanor arrests after 18 months.

CONCLUSIONS

Adaptive programming shows promise for enhancing short-term outcomes in drug courts; however, additional efforts are needed to extend the effects beyond the first 4 to 6 months of enrollment.