Tawana project-school nutrition program in Pakistan - its success, bottlenecks and lessons learned

Tawana Pakistan Project, a multifaceted pilot project (Sept. 2002 to June 2005) was funded by the Government of Pakistan to address poor nutritional status and school enrolment of primary school age girls. The core strategy was to create safe environment empowering village women to take collective decisions. Through reflective learning process women learnt to plan balanced menus, purchase food, prepare and serve a noon meal at school from locally available foods at nominal costs (USD 0.12/child). Aga Khan University partnered the government for the design, management, monitoring and evaluation of the project, 11 NGO\u27s facilitated implementation in 4035 rural government girls\u27 schools. Training was provided to 663 field workers, 4383 community organizers, 4336 school teachers and around 95 thousand rural women. Height and weight were recorded at baseline and every 6 months thereafter. Wasting, underweight and stunting decreased by 45%, 22% and 6% respectively. Enrolment increased by 40%. Women\u27s\u27 ability to plan balanced meals improved and \u3e 76% of all meals provided the basic three food groups by end of project. Government bureaucracy issues, especially at the district level proved to be the most challenging bottlenecks. Success can be attributed to synergies gained by dealing with nutrition, education and empowerment issues simultaneously

Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p

Ogbu and the debate on educational achievement: an exploration of the links between education, migration, identity and belonging

This paper looks at some of the issues raised by Ogbu’s work in relation to the education of different minority ethnic groups. Ogbu poses questions such as the value attached to education, its links to the future and its measurable outcomes in terms of ‘success’ as experienced by black participants. The desire for better life chances leads families to consider migration to a new country or resettlement within the same country, thus making migration both a local and a global phenomenon. As an example, attention is drawn to the situation facing South Asian children and their families in the UK. In terms of ethnicity and belonging, the wider question that is significant for many countries in the West after ‘Nine-Eleven’ is the education of Muslim children. A consideration of this current situation throws Ogbu’s identification of ‘autonomous minority’ into question. It is argued that a greater understanding of diverse needs has to be accompanied by a concerted effort to confront racism and intolerance in schools and in society, thus enabling all communities to make a useful contribution and to avoid the ‘risk’ of failure and disenchantment

Intersectional impact of multiple identities on social work education in the UK

This document is the Accepted Manuscript version of the following article: Ben Chi-pun Liu, ‘Intersectional impact of multiple identities on social work education in the UK’, Journal of Social Work, Vol 17(2): 226-242, March 2017. © 2016 The Author(s). DOI to the published version: 10.1177/1468017316637220. Reprinted by permission of SAGE Publications.Summary: The study reviews the records of 671 social work students and graduates including the seven intakes from the first cohort in 2003/2004 to the intake in 2010/2011 to examine the interacting effect of learning difficulties, ethnicity and gender on the completion of social work training at a university in the South East of England. Findings: Among the students, 79.9% of them were female, 50.1% were black, 27.9% white, 10.7% Asian and 11.3% other ethnicities. A majority of students did not report any disability. Among those who did (n ¼ 84), 52.3% (n ¼ 44) reported a learning difficulty.The percentage of students who have successfully completed the training is 76.4%, a completion rate that is comparable to the UK’s national figure. Having controlled the confounding variables, hierarchical logistic regression identified the risk factor for dropoutfrom undergraduate social work programme as black female students with learning difficulties (odds ratio ¼ 0.100, 95% confidence interval ¼ 0.012–0.862, p < 0.05). Findings suggested that students with multiplicity of identities, i.e. being black and female and with a learning difficulty, have a lower probability to complete the programme successfully. Applications: Strategies for tackling the intersecting disadvantages of race, gender and disabilities in social work training should embrace three principles: providing continuous support, focusing on how the support is provided and addressing contextual and structural barriers.Peer reviewedFinal Accepted Versio

Finite Difference Solution of Conjugate Heat Transfer in Double Pipe with Trapezoidal Fins

A conjugate heat transfer problem on the shell side of a finned double pipe heat exchanger is numerically studied by suing finite difference technique. Laminar flow with isothermal boundary conditions is considered in the finned annulus with fully developed flow region to investigate the influence of variations in the fin height, the number of fins and the fluid and wall thermal conductivities on the hydraulic and thermal design of the exchanger. The governing momentum and energy equations have been solved by a finite difference-based numerical algorithm. The improvement in heat transfer rates, the exchanger performance and the optimum configurations are discussed

Missing Dimensions in Addressing Child Malnutrition in Pakistan: Lessons from the Tawana Experience

This article uses the Tawana Pakistan Project (TPP) as a case study of how to promote self?sustaining improvements in nutrition status. The programme used a participatory approach to mobilisation around malnutrition, had a transparent information system for monitoring resources, and brought a focus on deeper structural issues to the analysis of malnutrition. We argue that Tawana was cancelled because it did not provide sufficient opportunities for leakage and diversion. This amply illustrates the political nature of nutrition. Yet efforts to reduce malnutrition continue to focus primarily on technical fixes. For long?term change researchers and programme implementers will need to understand the political space they operate within. Tawana was not perfect but it offered a glimpse of a different way forward, one that struck a balance between inclusiveness and action; transparency and accountability; and health and social science perspectives. It affected politics and was undone by them. It is not too late to include these concepts and approaches in future nutrition policies and interventions