Impact of Covid-19 on farming systems in Europe through the lens of resilience thinking

CONTEXT

Resilience is the ability to deal with shocks and stresses, including the unknown and previously unimaginable, such as the Covid-19 crisis.

OBJECTIVE

This paper assesses (i) how different farming systems were exposed to the crisis, (ii) which resilience capacities were revealed and (iii) how resilience was enabled or constrained by the farming systems' social and institutional environment.

METHODS

The 11 farming systems included have been analysed since 2017. This allows a comparison of pre-Covid-19 findings and the Covid-19 crisis. Pre-Covid findings are from the SURE-Farm systematic sustainability and resilience assessment. For Covid-19 a special data collection was carried out during the early stage of lockdowns.

RESULTS AND CONCLUSIONS

Our case studies found limited impact of Covid-19 on the production and delivery of food and other agricultural products. This was due to either little exposure or the agile activation of robustness capacities of the farming systems in combination with an enabling institutional environment. Revealed capacities were mainly based on already existing connectedness among farmers and more broadly in value chains. Across cases, the experience of the crisis triggered reflexivity about the operation of the farming systems. Recurring topics were the need for shorter chains, more fairness towards farmers, and less dependence on migrant workers. However, actors in the farming systems and the enabling environment generally focused on the immediate issues and gave little real consideration to long-term implications and challenges. Hence, adaptive or transformative capacities were much less on display than coping capacities. The comparison with pre-Covid findings mostly showed similarities. If challenges, such as shortage of labour, already loomed before, they persisted during the crisis. Furthermore, the eminent role of resilience attributes was confirmed. In cases with high connectedness and diversity we found that these system characteristics contributed significantly to dealing with the crisis. Also the focus on coping capacities was already visible before the crisis. We are not sure yet whether the focus on short-term robustness just reflects the higher visibility and urgency of shocks compared to slow processes that undermine or threaten important system functions, or whether they betray an imbalance in resilience capacities at the expense of adaptability and transformability.

SIGNIFICANCE

Our analysis indicates that if transformations are required, e.g. to respond to concerns about transnational value chains and future pandemics from zoonosis, the transformative capacity of many farming systems needs to be actively enhanced through an enabling environment.

Delivering an enabling environment and multiple benefits for land degradation neutrality: Stakeholder perceptions and progress

Achieving land degradation neutrality (LDN) was adopted by countries in 2015 as one of the targets of the global Sustainable Development Goals (SDGs). As LDN is a relatively new concept there is an increasing need for evidence on the potential socio-economic and environmental benefits of LDN as well as how an enabling environment for implementing LDN measures can be developed. This paper summarises the results from a global survey of LDN stakeholders, and a review of national progress in target setting that was commissioned by the United Nations Convention to Combat Desertification (UNCCD) in 2018. The study presents the perceptions of relevant stakeholders on the key components of an enabling environment for achieving and maintaining LDN (institutional, financial, policy/regulatory, and science-policy) as well as expectations of multiple benefits from its implementation. We also highlight key challenges and gaps in progress to date that are emerging from ongoing national target setting programs to implement LDN. The study finds that progress in implementing LDN has been widespread across countries. However there remains a lack of awareness of LDN and its key concepts along with high-level political buy-in. This may be impeding the integration of LDN into national development planning and budgeting processes where progress was assessed as limited. National capacities for securing land tenure and governance arrangements and integrated land use planning were perceived as comparatively low, further hampering the implementation of LDN. Despite these gaps, most stakeholders (>90 %) who participated in the global survey expected LDN to deliver a broad range of multiple benefits for human wellbeing, livelihoods and the natural environment. We argue that greater efforts are needed to raise awareness of LDN, educate core stakeholders in its concepts, enablers and benefits, raise its political profile, and provide evidence on national measures that will support implementation of LDN.

Comparing the German enabling environment for nationwide Water Safety Plan implementation with international experiences: Are we still thinking big or already scaling up?

Ensuring safe drinking-water is the target of the Water Safety Plan (WSP) approach, which has been successfully applied to a large number of water supply systems around the world. Effective country-wide scaling up of WSP implementation requires an enabling environment at the policy level. By utilizing a multi-step mixed methods approach, this study summarizes international experience with WSP implementation and scaling-up efforts following the 8 steps of the WSP road map published by WHO and IWA for an enabling environment, shows what steps Germany has in place, and compares this with published international experience to inspire further policy action. Contrasting the international experience to the German situation revealed several overlaps but also profound differences, which, in turn, offer opportunities for mutual learning. Most experience in Germany and internationally is documented for the earlier steps of the WSP road map. Information particularly on developing a national strategy, securing financial instruments, activities to support continual implementation of WSPs and on review of the overall WSP experiences and sharing lessons learned appears to be scarce, while the importance of training, collaboration and alliances, and the value of a regulatory push are often stressed. In Germany, stakeholder engagement, guidance documents and workshop materials have been of vital importance. Information that could particularly inform further action in Germany mostly relate to considering a national WSP strategy, and how to shape an approach for external quality assurance of WSPs.

Scaling agricultural mechanization services in smallholder farming systems: Case studies from sub-Saharan Africa, South Asia, and Latin America

There is great untapped potential for farm mechanization to support rural development initiatives in low- and middle-income countries. As technology transfer of large machinery from high-income countries was ineffective during the 1980s and 90s, mechanization options were developed appropriate to resource poor farmers cultivating small and scattered plots. More recently, projects that aim to increase the adoption of farm machinery have tended to target service providers rather than individual farmers. This paper uses the Scaling Scan tool to assess three project case studies designed to scale different Mechanization Service Provider Models (MSPMs) in Mexico, Zimbabwe, and Bangladesh. It provides a useful framework to assess the gap between international lessons learned on scaling captured in forty tactical questions over ten "scaling ingredients" as perceived by stakeholders involved in the projects, as well as private sector actors and government employees. Although at first sight the case studies seem to successfully reach high numbers of end users, the assessment exposes issues around the sustainable and transformative nature of the interventions. These are highly influenced by the design of the projects and by the environment and context of the intervention areas. Across the three case studies, large-scale adoption of the models was found to be hampered by lack of finance to set up MSPMs and insufficient collaboration among the value chain actors to strengthen and foster Mechanization Service Provider (MSP) entrepreneurs. Applying a scaling perspective on each case study project exposed important lessons on minimizing project dependencies. Positive examples include integration of capacity development materials in vocational training centers in Zimbabwe, promotion of MSPMs by other donors in East Africa and levering of nearly USD six million of private sector investment in appropriate machinery in Bangladesh. On the other hand, there is still a high dependency on the projects in terms of coaching of service providers, facilitating collaboration along the value chain, and provision of leadership and advocacy to address issues at governance level. These results have important implications for similar development interventions aimed at increasing smallholder access to mechanization services at scale and is to our knowledge the first cross-continental assessment of these issues to date.

The whole is more than the sum of the parts: establishing an enabling health system environment for reducing acute child malnutrition in a rural South African district

There is a gap in understanding of how national commitments to child nutrition are translated into sub-national implementation. This article is a mixed methods case study of a rural South African health district which achieved accelerated declines in morbidity and mortality from severe acute malnutrition (SAM) in young children, following a district health system strengthening (HSS) initiative centred on real-time death reporting, analysis and response. Drawing on routine audit data, the declining trends in under-five admissions and in-hospital mortality for SAM over a 5-year period are presented, comparing the district with two others in the same province. Adapting Gillespie et al.'s typology of 'enabling environments' for Maternal and Child Nutrition, and based on 41 in-depth interviews and a follow-up workshop, the article then presents an analysis of how an enabling local health system environment for maternal-child health was established, creating the conditions for achievement of the SAM outcomes. Embedded in supportive policy and processes at national and provincial levels, the district HSS interventions and the manner in which they were implemented produced three kinds of system-level change: knowledge and use of evidence by providers and managers ('ways of thinking'), leadership, participation and coordination ('ways of governing') and inputs and capacity ('ways of resourcing'). These processes mainstreamed responsibility, deepened accountability and triggered new service delivery and organizational practices and mindsets. The article concludes that it is possible to foster enabling district environments for the prevention and management of acute malnutrition, emphasizing the multilevel and simultaneous nature of system actions, where action on system 'software' complements the 'hardware' of HSS interventions, and where the whole is more than the sum of the parts.

Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach

BACKGROUND

An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers' knowledge, perception of enabling environments, and perception of severity of maternal sepsis.

METHODS

We used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ². Logistic regressions were performed to adjust for selected variables.

RESULTS

Analysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities.

CONCLUSIONS

Awareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.

"There is no time for knowing each other": Quality of care during childbirth in a low resource setting

OBJECTIVE

To explore women's and healthcare provider's perspectives of what quality of care during childbirth means to them and how this can be improved.

DESIGN

14 Focus Group Discussions (FGD) with women and 27 Key Informant Interviews (KII) with healthcare providers. Thematic framework analysis was used.

SETTING

14 public healthcare facilities across two districts in Malawi. Mothers who had given birth at a healthcare facility within the last 7-42 days and healthcare providers who were directly involved in maternity care.

FINDINGS

Perceptions of what constitutes good quality of care differed substantially. For healthcare providers, the most important characteristics of good quality care included structural aspects of care such as availability of materials, and sufficient human resources. For women, patient-centred care including a positive relationship and experience was prioritised. However, both groups had similar views on what constitutes poor quality of care; unwelcoming reception on admission, non-consented care, physical and verbal abuse were described as examples of poor care. Shortage of staff, poor labour room design and a non-functional referral system were key barriers identified.

KEY CONCLUSIONS

Women as well as healthcare providers want good quality, professional care at birth and are disappointed if this is not in place.

IMPLICATION FOR PRACTICE

There is a need to incorporate women as well as healthcare provider's views when designing, implementing, monitoring and evaluating maternal health programmes. For a positive birth experience, a healthcare facility needs to have an enabling environment and good communication between healthcare providers and women should be actively promoted.

What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa

BACKGROUND

Breede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level.

METHODS

Focus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme.

RESULTS

The participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition's development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. "People" were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance.

CONCLUSION

The study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.

Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia

BACKGROUND

Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving quality of care. The purpose of this study was to assess the quality of midwifery care during labor, delivery and immediate postpartum period.

METHODS

A cross-sectional study using multiple data collection methods and a 2-stage cluster sampling technique was conducted from January 25 to February 14, 2015 in government health facilities of the Amhara National Regional State of Ethiopia. Direct observation of performance was used to determine competence of midwives in providing care during labor, delivery, and the first 6 h after childbirth. Inventory of drugs, medical equipment, supplies, and infrastructure was conducted to identify availability of resources in health facilities. Structured interview was done to assess availability of resources and performance improvement opportunities. Data analysis involved calculating percentages, means and chi-square tests.

RESULTS

A total of 150 midwives and 56 health facilities were included in the study. The performance assessment showed 16.5% of midwives were incompetent, 72.4% were competent, and 11.1% were outstanding in providing routine intrapartum care. Forty five midwives were observed while managing 54 obstetric and newborn complications and 41 (91%) of them were rated competent. Inventory of resources found that the proportion of facilities with more than 75% of the items in each category was 32.6% for drugs, 73.1% for equipment, 65.4% for supplies, 47.9% for infection prevention materials, and 43.6% for records and forms. Opportunities for performance improvement were inadequate, with 31.3% reporting emergency obstetric and newborn care training, and 44.7% quarterly or more frequent supportive supervision. Health centers fared worse in provider competence, physical resources, and quality improvement practices except for supportive supervision visits and in-service training.

CONCLUSIONS

Although our findings indicate most midwives are competent in giving routine and emergency intrapartum care, the major gaps in the enabling environment and the significant proportion of midwives with unsatisfactory performance suggest that the conditions for providing quality intrapartum care are not optimal.