Search results for: community driven development

Authors: Lamia Ismayil

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The COVID-19 pandemic has drastically changed the everyday lives of people all over the world. This pandemic affects heavily the lifestyle of people in different aspects of life, including eating habits. The objective of this paper is to study the impact of the COVID-19 pandemic on key factors affecting food habits among the Community College of Qatar (CCQ) students. Method: The research is a cross-sectional survey that deployed a questionnaire among 217 CCQ students. Results: The results showed that 47.5% of the respondents were male and 52.5% female. In our previous study about 30% percentage obesity with a BMI of 30-35 was shown. Surprisingly, during the pandemic, the obesity percentage remains almost the same, but the BMI range jumped to 30-46. The nutritional knowledge of CCQ students is at an average level. Besides, during pandemic the personal eating habits continued to be imbalanced and getting unhealthier than in the pre-pandemic period. Regarding the key factors that could affect eating habits, most of the respondents reported that during the pandemic in the absence of restaurants they had daily meals with their families, and had a lack of physical activity. Besides, most of the respondents agree that they gained weight during the pandemic. These findings indicate that the pandemic changed the food habits and the lifestyle of Qatari students. Accordingly, increasing the awareness among college students (and Qatari community at large) is recommended. College students can be given some recommendations related to healthy eating tips to overcome the effect of pandemic on their health status. The detailed comparative analysis between pre- and post-pandemic eating habits of students can help reveal the main differences and give effective guidance to improve body composition and health status of students.

Keywords: food habits, BMI, obesity, COVID-19, nutritional knowledge, community college of Qatar, pandemic

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Authors: Kakali Bhadra

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Binding of small molecules to DNA and recently to RNA, continues to attract considerable attention for developing effective therapeutic agents for control of gene expression. This work focuses towards understanding interaction of harmalol, a dihydro beta-carboline alkaloid, with different nucleic acid motifs viz. double stranded CT DNA, single stranded A-form poly(A), double-stranded A-form of poly(C)·poly(G) and clover leaf tRNAphe by different spectroscopic, calorimetric and molecular modeling techniques. Results of this study converge to suggest that (i) binding constant varied in the order of CT DNA > poly(C)·poly(G) > tRNAphe > poly(A), (ii) non-cooperative binding of harmalol to poly(C)·poly(G) and poly(A) and cooperative binding with CT DNA and tRNAphe, (iii) significant structural changes of CT DNA, poly(C)·poly(G) and tRNAphe with concomitant induction of optical activity in the bound achiral alkaloid molecules, while with poly(A) no intrinsic CD perturbation was observed, (iv) the binding was predominantly exothermic, enthalpy driven, entropy favoured with CT DNA and poly(C)·poly(G) while it was entropy driven with tRNAphe and poly(A), (v) a hydrophobic contribution and comparatively large role of non-polyelectrolytic forces to Gibbs energy changes with CT DNA, poly(C)·poly(G) and tRNAphe, and (vi) intercalated state of harmalol with CT DNA and poly(C)·poly(G) structure as revealed from molecular docking and supported by the viscometric data. Furthermore, with competition dialysis assay it was shown that harmalol prefers hetero GC sequences. All these findings unequivocally pointed out that harmalol prefers binding with ds CT DNA followed by ds poly(C)·poly(G), clover leaf tRNAphe and least with ss poly(A). The results highlight the importance of structural elements in these natural beta-carboline alkaloids in stabilizing different DNA and RNA of various motifs for developing nucleic acid based better therapeutic agents.

Keywords: calorimetry, docking, DNA/RNA-alkaloid interaction, harmalol, spectroscopy

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Authors: Cao Yuping, Li Longfei, Zhao Xingfu, Zhang Yalin

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Purpose: This study examined the effects of exposure to domestic physical violence (DPV) on children’s behavior in a community sample. Method: Ninety-three 12-16 year-old adolescents exposed to DPV were matched with 54 adolescents with no exposure to DPV based on age, gender, family composition and parental age and education level. Participation included assessment with the Childhood Trauma Questionnaire (CTQ-SF) and Child Behavior Checklist (CBCL) by the adolescents and their parents respectively. Results: CBCL total score and anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing scores were significantly higher in adolescents exposed to DPV than those in controls (all ps<0.05).The CBCL total score and scores of anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing behaviors of boys were significantly higher in the research group than in the controls (all ps<0.05). Delinquency scores in abused adolescents were significantly higher than in DPV witnessed (p<0.05), but no other scores of CBCL were significant different. Different subtypes of behavioral problems were associated with different types of abuse. Conclusions: DPV exposure is associated with adverse behaviors in children, especially among boys. Children witness DPV alone have similar behavioral scores as the abused children. We recommend that both abused and DPV witness adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors.

Keywords: domestic violence, child, behavior, community, China

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Authors: H. E. Amolo

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The concepts of pollution or contamination and purification or ritual cleansing are very important concepts among traditional Africans. This is because in relation to human behaviors and attitudes, they constitute on the one hand what could be referred to as moral demands and on the other, what results in the default of such demands. The many taboos which a man has to observe are not to be regarded as things mechanical which do not touch the heart, but that the avoidance is a sacred law respected by the community. In breaking it, you offend the divine power’. Researches have shown that, Africans tenaciously hold the belief that, moral values are based upon the recognition of the divine will and that sin in the community must be expelled if perfect peace is to be enjoyed. Sadly enough, these moral values are gradually eroding in contemporary times. Thus, this study proposal calls for a survey of the passage from an African cultural context; how it can enhance the understanding of the text, as well as how it can complement its scholarly interpretation with the view of institutionalizing the concept of holiness as a means of bringing the people closer to God, and also instilling ethical purity and righteousness.

Keywords: cultural practices, Igbo ideology, purification, rituals

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Authors: Konstantinos Kottikas, Vlasis Stathakopoulos, Ioannis G. Theodorakis, Efthymia Kottika

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Theorists have argued that Market Orientation is comprised of two facets, namely the Market Driven and the Market Driving components. The present theoretical paper centers on the latter, which to date has been notably under-investigated. The term Market Driving (MD) pertains to influencing the structure of the market, or the behavior of market players in a direction that enhances the competitive edge of the firm. Presently, the main objectives of the paper are the specification of key antecedents and outcomes of Market Driving behavior. Market Driving firms behave proactively, by leading their customers and changing the rules of the game rather than by responding passively to them. Leading scholars were the first to conceptually conceive the notion, followed by some qualitative studies and a limited number of quantitative publications. However, recently, academicians noted that research on the topic remains limited, expressing a strong necessity for further insights. Concerning the key antecedents, top management’s Transformational Leadership (i.e. the form of leadership which influences organizational members by aligning their values, goals and aspirations to facilitate value-consistent behaviors) is one of the key drivers of MD behavior. Moreover, scholars have linked the MD concept with Entrepreneurship. Finally, the role that Employee’s Creativity plays in the development of MD behavior has been theoretically exemplified by a stream of literature. With respect to the key outcomes, it has been demonstrated that MD Behavior positively triggers firm Performance, while theorists argue that it empowers the Competitive Advantage of the firm. Likewise, researchers explicate that MD Behavior produces Radical Innovation. In order to test the robustness of the proposed theoretical framework, a combination of qualitative and quantitative methods is proposed. In particular, the conduction of in-depth interviews with distinguished executives and academicians, accompanied with a large scale quantitative survey will be employed, in order to triangulate the empirical findings. Given that it triggers overall firm’s success, the MD concept is of high importance to managers. Managers can become aware that passively reacting to market conditions is no longer sufficient. On the contrary, behaving proactively, leading the market, and shaping its status quo are new innovative approaches that lead to a paramount competitive posture and Innovation outcomes. This study also exemplifies that managers can foster MD Behavior through Transformational Leadership, Entrepreneurship and recruitment of Creative Employees. To date, the majority of the publications on Market Orientation is unilaterally directed towards the responsive (i.e. the Market Driven) component. The present paper further builds on scholars’ exhortations, and investigates the Market Driving facet, ultimately aspiring to conceptually integrate the somehow fragmented scientific findings, in a holistic framework.

Keywords: entrepreneurial orientation, market driving behavior, market orientation

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Authors: Nazia Jabeen, Denis Hyams-Ssekasi

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The study focuses on the determinants of food waste management (FWM) in one of the urban areas of Pakistan. One hundred and two households from the urban areas of Pakistan took part in the study via self-completed questionnaires, and data were analyzed. The research findings indicate that food waste management is a recurring issue, and households must do more to minimize or create business opportunities. Most households agree that food waste has significant implications for the community if not utilized and managed correctly. The value creation deriving from this zero-value resource provides a platform where householders see the benefit of food waste management. Based on the findings, this study acknowledges that food waste has significant economic and social impacts on the community. It concludes that minimization and optimum utilization of food waste create a pathway to business opportunities in urban areas.

Keywords: economic, social, food waste management, business opportunities, value creation

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Authors: Hanyu Wang, Guangdong Wang

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County-level areas serve as vital spatial units for advancing new urbanization and implementing the principles of low-carbon development, representing critical regions where conflicts between the two are pronounced. Using the 142 county-level units in the Chengdu-Chongqing city clusters as a case study, a coupled coordination model is employed to investigate the coupled coordination relationship and its spatiotemporal evolution between county-level new urbanization and low-carbon development levels. Results indicate that (1) from 2005 to 2020, the overall levels of new urbanization and low-carbon development in the Chengdu-Chongqing city clusters showed an upward trend but with significant regional disparities. The new urbanization level exhibited a spatial differentiation pattern of "high in the suburban areas, low in the distant suburbs, and some counties standing out." The temporal change in low-carbon development levels was not pronounced, yet spatial disparities were notable. (2) The overall coupling coordination degree between new urbanization and low-carbon development is transitioning from barely coordinated to moderately coordinated. The lag in new urbanization levels serves as a primary factor constraining the coordinated development of most counties. (3) Based on the temporal evolution of development states, all county units can be categorized into four types: coordinated demonstration areas, synergistic improvement areas, low-carbon transformation areas, and development lag areas. The research findings offer crucial reference points for spatial planning and the formulation of low-carbon development policies.

Keywords: county units, coupling coordination, low-carbon development, new urbanization

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Authors: Naila Awan, Shahrukh Inam

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This study was conducted to highlight the role of basic health units in district Swabi, which provides primary health services to the people of district Swabi having four tehsils. Tehsil Swabi was selected purposively for the study. Three villages were purposively selected from district Swabi. A sum of 110 respondents was randomly selected for interview i.e., 27 from Botakaa, 39 from Gulatee, and 44 from Darra Cham, using proportion allocation sampling technique. A pretested and well-designed interview schedule was used to collect as per the objective and Chi square test was applied to find an association between the quality of medicines and health improvement. The output of the test shows that the government was doing its best and providing enough facilities to the individuals at the healthcare units, and they were utilizing them. These resources were easily accessible to the people of the community. Medicines provided by the government were of good quality and quantity. There were also school health sessions and community health sessions (SHS/CHS) to deliver useful information and awareness regarding health problems and diseases were conducted. The staff of the BHU was present at work time and was performing their duties. The respondents seemed satisfied with their behavior and the duty of the staff. However, there were no emergency resources existing at the BHU after the working hours of the medical staff. It is recommended that government should provide appropriate quantity and quality of medicines to the basic health units so that these healthcare units don’t have to face any shortages regarding medicines at the end of the month. In addition, laboratory and blood testing facilities need to be provided in the basic health units, and also the infrastructure should be made suitable, satisfactory, and more functional.

Keywords: community health session, basic health units, outpatient department, tuberculosis

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Authors: Abhay Vir Singh Kanwar

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The pharmaceutical industry today is a multi-billion dollar business and yet disadvantages people in many corners of the globe who are still dying in large numbers from curable illnesses for lack of access to drugs. The astronomical prices of essential and life-saving drugs is not just an economic problem that can be settled through clever market strategies but is an ethical issue, given the accumulated wealth of today’s humanity and the sense of global justice that it increasingly comes to share. In this paper, I make a very practical argument for what I shall call ‘the ethical healthcare paradigm’, which, I propose, can replace the economistic paradigm that can still drive the healthcare sector without creating spillover effects on the market. Taking off from the ethical-philosophical argument for recognizing every individual’s right to capability to be healthy, I shall come to the focused practical proposal of the cost-rationalization and universal availability of essential, life-saving drugs through the undertaking of research and development funding for drug innovation by the business establishment as such in terms of the concept of CSR. The paper will first expose the concepts of basic and fundamental capabilities in relation to education and health, after which it will focus on the right to capability to be healthy of every person. In the third section, it will discuss the ‘ethical healthcare paradigm’ as opposed to the economistic health paradigm and will argue that the patient will have to be considered the primary stakeholder of this paradigm or the very ‘subject’ of healthcare. The next section will be on an ethical-historical critique of the pharmaceutical industry’s profit driven economism. The section after that will look at the business operation and the stages in the life cycle of a drug that comes to the market in order to understand the risks, strengths and problems of the pharmaceutical industry. Finally, the paper will discuss the concept of CSR in relation to the ethical healthcare paradigm in order to propose CSR funding in research and development for innovation on drugs so that life-saving drugs can be made available to every sick person cost-effectively.

Keywords: capability approach, healthcare, CSR, patient

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Authors: M. L. Seretlo-Rangata, T. Sodi, S. Govender

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Despite interventions by various governments to regulate water demand and address water scarcity, literature shows that billions of people across the world continue to struggle with access because not everyone contributes equally to conservation efforts. Behavioral factors such as individual and collective aspects of cognition and commitment have been found to play an important role in water conservation. The aim of the present study was to explore the perceptions of community members in the Lephalale area, Limpopo province, towards water conservation with a view to developing an explanatory psychological model on water conservation. Twenty (20) participants who relied on communal taps to access water in Lephalale Local Municipality, Limpopo province, were selected through purposeful sampling. In-depth, semi-structured, individual face-to-face interviews were used to gather data and were analyzed utilizing thematic content analysis (TCA). The research findings revealed that there are various psychological effects of water scarcity on communities, such as emotional distress, interpersonal conflicts and disruptions of daily activities of living. Additionally, the study results showed that the coping strategies developed by participants to deal with water scarcity included adopting alternative water use behaviors as well as adjusting current behaviors and lifestyles. Derived from the study findings, a psychological model of water conservation was developed. The model incorporates some ideas from the Value-Belief-Norm (VBN) theory and the Afrocentric theory. The model suggests that people’s worldviews, including their values, beliefs and culture, are significant determinants of their pro-environmental behaviors. The study concludes by recommending that authorities and policymakers should consider psychological factors when developing water management programs, strategies and interventions with the consultation of psychology experts.

Keywords: water conservation, psychological model, pro-environmental behaviour, conservation psychology, water-use behaviour

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Authors: Ying-Hsiu Chen, Pao-Peng Hsu

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This paper adopts a two-stage data envelopment analysis to explore the impacts of financial development and bank operational scale on bank efficiencies. The sample comprises of unbalanced panel data of 32 Taiwanese enlisted in domestic commercial banks over the period 1998 to 2013. Empirical results show that technical efficiency is positively related to financial development, whereas the effect of financial development on scale efficiency is insignificant. The effect of operational scale exerts a significantly positive effect on bank efficiencies, but the gain of efficiency is decreased gradually when operational scale increases. Furthermore, increase in capital adequacy ratio and market power of banks leads to a growth of bank efficiencies.

Keywords: financial development, operational scale, efficiency, DEA

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Authors: M. Vlahovic

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This paper presents a model of public finances, which combines three concepts: participatory budgeting, crowdfunding and blockchain technology. Participatory budgeting is defined as a process in which community members decide how to spend a part of community’s budget. Crowdfunding is a practice of funding a project by collecting small monetary contributions from a large number of people via an Internet platform. Blockchain technology is a distributed ledger that enables efficient and reliable transactions that are secure and transparent. In this hypothetical model, the government or authorities on local/regional level would set up a platform where they would propose public projects to citizens. Citizens would browse through projects and support or vote for those which they consider justified and necessary. In return, they would be entitled to a tax relief in the amount of their monetary contribution. Since the blockchain technology enables tracking of transactions, it can be used to mitigate corruption, money laundering and lack of transparency in public finances. Models of its application have already been created for e-voting, health records or land registries. By presenting a model of application of blockchain technology in public finances, this paper takes into consideration the potential of blockchain technology to disrupt governments and make processes more democratic, secure, transparent and efficient. The framework for this paper consists of multiple streams of research, including key concepts of direct democracy, public finance (especially the voluntary theory of public finance), information and communication technology, especially blockchain technology and crowdfunding. The framework defines rules of the game, basic conditions for the implementation of the model, benefits, potential problems and development perspectives. As an oversimplified map of a new form of public finances, the proposed model identifies primary factors, that influence the possibility of implementation of the model, and that could be tracked, measured and controlled in case of experimentation with the model.

Keywords: blockchain technology, distributed ledger, participatory budgeting, crowdfunding, direct democracy, internet platform, e-government, public finance

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Authors: Vivian Isaac, A. T. Joteeshwaran, Craig McLachlan

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The University of New South Wales (UNSW) Rural Clinical School has a strategic collaborative focus on chronic disease and public health. Our objectives are to understand rural environmental and biological interactions in vulnerable community populations. The UNSW Rural Clinical School translational model is a spoke and hub network. This spoke and hub model connects rural data and biological specimens with city based collaborative public health research networks. Similar spoke and hub models are prevalent across research centers in India. The Australia-India Council grant was awarded so we could establish sustainable public health and community research collaborations. As part of the collaborative network we are developing strategies around data and biological sharing platforms between Indian Institute of Public Health, Public Health Foundation of India (PHFI), Hyderabad and Rural Clinical School UNSW. The key objective is to understand how research collaborations are conducted in India and also how data can shared and tracked with external collaborators such as ourselves. A framework to improve data sharing for research collaborations, including DNA was proposed as a project outcome. The complexities of sharing biological data has been investigated via a visit to India. A flagship sustainable project between Rural Clinical School UNSW and PHFI would illustrate a model of data sharing platforms.

Keywords: data sharing, collaboration, public health research, chronic disease

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Authors: O. D. Ohijeagbon, Oluseyi O. Ajayi, M. Ogbonnaya, Ahmeh Attabo

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This study analyzed the electricity generation potential from wind at seven sites spread across seven states of the North-Central region of Nigeria. Twenty-one years (1987 to 2007) wind speed data at a height of 10m were assessed from the Nigeria Meteorological Department, Oshodi. The data were subjected to different statistical tests and also compared with the two-parameter Weibull probability density function. The outcome shows that the monthly average wind speeds ranged between 2.2 m/s in November for Bida and 10.1 m/s in December for Jos. The yearly average ranged between 2.1m/s in 1987 for Bida and 11.8 m/s in 2002 for Jos. Also, the power density for each site was determined to range between 29.66 W/m2 for Bida and 864.96 W/m2 for Jos, Two parameters (k and c) of the Weibull distribution were found to range between 2.3 in Lokoja and 6.5 in Jos for k, while c ranged between 2.9 in Bida and 9.9m/s in Jos. These outcomes points to the fact that wind speeds at Jos, Minna, Ilorin, Makurdi and Abuja are compatible with the cut-in speeds of modern wind turbines and hence, may be economically feasible for wind-to-electricity at and above the height of 10 m. The study further assessed the potential and economic viability of standalone wind generation systems for off-grid rural communities located in each of the studied sites. A specific electric load profile was developed to suite hypothetic communities, each consisting of 200 homes, a school and a community health center. Assessment of the design that will optimally meet the daily load demand with a loss of load probability (LOLP) of 0.01 was performed, considering 2 stand-alone applications of wind and diesel. The diesel standalone system (DSS) was taken as the basis of comparison since the experimental locations have no connection to a distribution network. The HOMER® software optimizing tool was utilized to determine the optimal combination of system components that will yield the lowest life cycle cost. Sequel to the analysis for rural community utilization, a Distributed Generation (DG) analysis that considered the possibility of generating wind power in the MW range in order to take advantage of Nigeria’s tariff regime for embedded generation was carried out for each site. The DG design incorporated each community of 200 homes, freely catered for and offset from the excess electrical energy generated above the minimum requirement for sales to a nearby distribution grid. Wind DG systems were found suitable and viable in producing environmentally friendly energy in terms of life cycle cost and levelised value of producing energy at Jos ($0.14/kWh), Minna ($0.12/kWh), Ilorin ($0.09/kWh), Makurdi ($0.09/kWh), and Abuja ($0.04/kWh) at a particluar turbine hub height. These outputs reveal the value retrievable from the project after breakeven point as a function of energy consumed Based on the results, the study demonstrated that including renewable energy in the rural development plan will enhance fast upgrade of the rural communities.

Keywords: wind speed, wind power, distributed generation, cost per kilowatt-hour, clean energy, North-Central Nigeria

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Authors: Alan Berman, Mark Brady

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The phenomenon of homophobia and transphobia in the United States detrimentally impacts the health, wellbeing, and dignity of school students who identify with the LGBTQ+ community. These negative impacts also compromise the participation of LGBTQ+ individuals in the wider life of educational domains and endanger the potential economic, social and cultural contribution this community can make to American society. The recent 6:3 majority decision of the US Supreme Court in Dobbs v Jackson Women’s Health Organization expressly overruled the 1973 decision in Roe v Wade and the 1992 Planned Parenthood v Casey decision. This study will canvass the bases upon which the court in Dobbs overruled longstanding precedent established in Roe and Casey. It will examine the potential implications for the LGBTQ community of the result in Dobbs. The potential far-reaching consequences of this case are foreshadowed in a concurring opinion by Justice Clarence Thomas, suggesting the Court should revisit all substantive due process cases. This includes notably the Lawrence v Texas case (invalidating sodomy laws criminalizing same-sex relations) and the Obergefellcase (upholding same-sex marriage). Finally, the study will examine the likely impact of the uncertainty brought about by the decision in Doddsfor LGBTQ students in US educational institutions. The actions of several states post-Dobbs, reflects and exacerbates the problems facing LGBTQ+ students and uncovers and highlights societal homophobia and transphobia.

Keywords: human rights, LGBT rights, right to personal dignity and autonomy, substantive due process rights

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Authors: Kuei-Yu Chien, Hsiu-Yu Chiu, Chia-Nan Chen, Shu-Chen Chen

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Background: Frailty is associated with decreased physical performances that affect mobility of the elderly. Time up and go test (TUG) was the common method to evaluate mobility in the community. The purpose of this study was to compare the parameters in different stages of Time up and go test (TUG) and physical performance between pre-frail elderly (PFE) and non-frail elderly (NFE). We also investigated the relationship between TUG parameters and physical performance. Methods: Ninety-two community-dwelling older adults were as participants in this study. Based on Canadian Study of Health and Aging Clinical Frailty Scale, 22 older adults were classified as PFE (71.77 ± 6.05 yrs.) and 70 were classified as NFE (71.2 ± 5.02 yrs.). We performed body composition and physical performance, including balance, muscular strength/endurance, mobility, cardiorespiratory endurance, and flexibility. Results: Pre-frail elderly took significantly longer time than NFE in TUG test (p=.004). Pre-frail elderly had lower turning average angular velocity (p = .017), turning peak angular velocity (p = .041) and turning-stand to sit peak angular velocity (p = .037) than NFE. The turning related parameters related to open-eye stand on right foot, 30-second chair stand test, back scratch, and 2-min step tests. Conclusions: Turning average angular velocity, turning peak angular velocity and turning-stand to sit peak angular velocity mainly affected the TUG performance. We suggested that static/dynamic balance, agility, flexibility, and muscle strengthening of lower limbs exercise were important to PFE.

Keywords: mobility, aglity, active ageing, functional fitness

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Authors: Alessandro Andre Leme

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To analyze three Brazilian think tanks: a) Fernando Henrique Foundation; b) Celso Furtado International Center; c) Millennium Institute and how they dispute interpretations about the type of development and State that should be adopted in Brazil. We will make use of Network and content analysis of the sites. The analyzes show a dispute that goes from a defense of ultraliberalism to developmentalism, going through a hybrid between State and Market voiced in each of the Think Tanks.

Keywords: sociopolitical and economic thinking, development, strategies, intellectuals, state

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Authors: Natalia Alvarado, Myldred Hernandez-Gonzalez, Mary Laird, Madeline Phillips, Elizabeth Miller, Luis Mendez, Teresa Satterfield Linares

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Objectives: Focusing on the reported levels of depressive symptoms from Hispanic individuals in the U.S. during the ongoing COVID-19 pandemic, we analyze the psychological effects of being labeled an ‘essential worker/trabajador(a) esencial.’ We situate this attribute within the complex context of how an individual’s mental health is linked to work status and his/her community’s attitude toward such a status. Method: 336 Spanish-speaking adults (Mage = 34.90; SD = 11.00; 46% female) living in the U.S. participated in a mixed-method study. Participants completed a self-report Spanish-language survey consisting of COVID-19 prompts (e.g., Soy un trabajador esencial durante la pandemia. I am an ‘essential worker’ during the pandemic), civic engagement scale (CES) attitudes (e.g., Me siento responsable de mi comunidad. I feel responsible for my community) and behaviors (e.g., Ayudo a los miembros de mi comunidad. I help members of my community), and the Center for Epidemiological Studies Depression Scale (e.g., Me sentía deprimido/a. I felt depressed). The survey was conducted several months into the pandemic and before the vaccine distribution. Results: Regression analyses show that being labeled an essential worker was correlated to CES attitudes (b= .28, p < .001) and higher CES behaviors (b= .32, p < .001). Essential worker status also reported higher levels of depressive symptoms (b= .17, p < .05). In addition, we found that CES attitudes and CES behaviors were related to higher levels of depressive symptoms (b= .11, p <.05, b = .22, p < .001, respectively). These findings suggest that those who are on the frontlines during the COVID-19 pandemic suffer higher levels of depressive symptoms, despite their affirming community attitudes and behaviors. Discussion: Hispanics/Latinxs make up 53% of the high-proximity employees who must work in person and in close contact with others; this is the highest rate of any racial or ethnic category. Moreover, 31% of Hispanics are classified as essential workers. Our outcomes show that those labeled as trabajadores esenciales convey attitudes of remaining strong and resilient for COVID-19 victims. They also express community attitudes and behaviors reflecting a sense of responsibility to continue working to help others during these unprecedented times. However, we also find that the pressure of maintaining basic needs for others exacerbates mental health challenges and stressors, as many essential workers are anxious and stressed about their physical and economic security. As a result, community attitudes do not protect from depressive symptoms as Hispanic essential workers are failing to balance everyone’s needs, including their own (e.g., physical exhaustion and psychological distress). We conclude with a discussion on alternatives to the phrase ‘essential worker’ and of incremental steps that can be taken to address pandemic-related mental health issues targeting US Hispanic workers.

Keywords: COVID-19, essential worker, mental health, race and ethnicity

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Authors: Yajing Jiang, Jing Wu

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Residential area construction links many problems such as population resources, ecology, social values, public services and transportation in the city. After Chinese housing reform, a large number of residential area development accompanied by the loss of agricultural and ecological land. To explore the future of Chinese urban residential area, this article concentrates on how the 'Compact Settlement' behaves in improving the living environment and saving the resources. Through the research of residential area in Hangzhou, there are some determines that increasing the development intensity of the area can indeed bring some improvement in the overall environment. In conclusion, possible design alternatives are discussed for leading Chinese urban development towards a more sustainable path.

Keywords: compact city development, environmental sustainability, residential area, Hangzhou

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Authors: Probuddha Mukhopadhyay

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The infiltration of key elements to the civil structure is foraying its way to reclaim, what is its own. The reclamation of lives and spaces, once challenged, becomes a consistent process of ingress, disguised as parallels to the moving city, disperses into discourses often unheard of and conveniently forgotten. In this age of 'hyper'-urbanization, there are solutions suggested to a plethora of issues faced by citizens, in improving their standards of living. Problems are ancillary to proposals that emerge out of the underlying disorders of the townscape. These interventions result in the formulation of urban policies, to consolidate and optimize, to regularize and to streamline resources. Policy and practice are processes where the politics in policies define the way in which urban solutions are prescribed. Social constraints, that formulate the various cycles of order and disorders within the urban realm, are the stigmas for such interventions. There is often a direct relation of policy to place, no matter how people-centric it may seem to be projected. How we live our lives depends on where we live our lives - a relative statement for urban problems, varies from city to city. Communal compositions, welfare, crisis, socio-economic balance, need for management are the generic roots for urban policy formulation. However, in reality, the gentry administering its environmentalism is the criterion, that shapes and defines the values and expanse of such policies. In relation to the psycho-spatial characteristic of urban spheres with respect to the other side of this game, there have been instances, where the associational values have been reshaped by interests. The public domain reclaimed for exclusivity, thus creating fortified neighborhoods. Here, the citizen cumulative is often drifted by proposals that would over time deplete such landscapes of the city. It is the organized rebellion that in turn formulates further inward looking enclaves of latent aggression. In recent times, it has been observed that the unbalanced division of power and the implied processes of regulating the weak, stem the rebellion who respond in kits and parts. This is a phenomenon that mimics the guerilla warfare tactics, in order to have systems straightened out, either by manipulations or by force. This is the form of the city determined by the various forms insinuated by the state of city wide decisions. This study is an attempt at understanding the way in which development is interpreted by the state and the civil society and the role that community driven processes undertake to reinstate their claims to the city. This is a charter of consolidated patterns of negotiations that tend to counter policies. The research encompasses a study of various contested settlements in two cities of India- Mumbai and Kolkata, tackling dissent through spatial order. The study has been carried out to identify systems - formal and informal, catering to the most challenged interests of the people with respect to their habitat, a model to counter the top-down authoritative framework challenging the legitimacy of such settlements.

Keywords: urban design, insurgence, tactical urbanism, urban governance, civil society, state

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Authors: Zainul A. Khan, Malik Z. Abdin, Jawaid A. Khan

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Begomoviruses belonging to the family Geminiviridae, have single-stranded circular DNA genomes that are monopartite or bipartite. The large intergenic region (LIR) of the monopartite and common region (CR) of bipartite begomoviruses possess promoter activity in their genomes. In this study, we have characterized novel bidirectional promoters from Cotton leaf curl Burewala virus (CLCuBuV) genome using high-throughput software and analyzed with PlantCARE, PLACE, Cister and PlantPAN databases. The promoters (Rep and CP promoters) were assayed both in stable and transient expression systems in tobacco as well as cotton plants. Rep and CP-based promoters from the LIR sequence of CLCuBuV and 35S promoter of Cauliflower mosaic virus (CaMV) were tagged with β-glucuronidase (GUS) and green fluorescent protein (GFP) reporter genes to check the efficacy of the promoters. Histochemical staining of GUS in transformed tobacco (Nicotiana tabacum cv. Xanthi) leaves showed higher GUS expression driven by CLCuBuV Rep (complimentary sense) promoter as compared to conventional CaMV 35S promoter and CLCuBuV CP (virion sense) promoter, respectively. GUS activity in individual plant cells driven by CLCuBuV Rep, CLCuBuV CP, and CaMV 35S promoter were quantified through fluorometric GUS assay and reverse transcription quantitative real-time PCR (RT-qPCR). The expression level of GUS tagged with CLCuBuV Rep promoter in the transformed tobacco plants was obtained 2 to 4 fold higher than CaMV 35S promoter. When CLCuBuV CP promoter was used, lower expression level was monitored than that by CaMV 35S promoter. The expression of GFP-tagged with CLCuBuV promoters was also investigated through agroinfiltration. The CLCuBuV Rep promoters showed stronger consistent transient expression in the leaves of N. benthamiana, N. tabacum and Gossypium hirsutum plants when compared with CaMV 35S and CLCuBuV CP promoter.

Keywords: Begmovirus, bidirectional promoter, CaMV 35S promoter, GFP, GUS, qPCR

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Authors: Hanan Algarni

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Background: Impairment of walking and balance skills has negative impact on functional independence and community participation after stroke. Gait recovery is considered a primary goal in rehabilitation by both patients and physiotherapists. Treadmill training coupled with virtual reality technology is a new emerging approach that offers patients with feedback, open and random skills practice while walking and interacting with virtual environmental scenes. Objectives: To synthesize the evidence around the effects of the VR treadmill training on gait speed and balance primarily, functional independence and community participation secondarily in stroke patients. Methods: Systematic review was conducted; search strategy included electronic data bases: MEDLINE, AMED, Cochrane, CINAHL, EMBASE, PEDro, Web of Science, and unpublished literature. Inclusion criteria: Participant: adult >18 years, stroke, ambulatory, without severe visual or cognitive impartments. Intervention: VR treadmill training alone or with physiotherapy. Comparator: any other interventions. Outcomes: gait speed, balance, function, community participation. Characteristics of included studies were extracted for analysis. Risk of bias assessment was performed using Cochrane's ROB tool. Narrative synthesis of findings was undertaken and summary of findings in each outcome was reported using GRADEpro. Results: Four studies were included involving 84 stroke participants with chronic hemiparesis. Interventions intensity ranged (6-12 sessions, 20 minutes-1 hour/session). Three studies investigated the effects on gait speed and balance. 2 studies investigated functional outcomes and one study assessed community participation. ROB assessment showed 50% unclear risk of selection bias and 25% of unclear risk of detection bias across the studies. Heterogeneity was identified in the intervention effects at post training and follow up. Outcome measures, training intensity and durations also varied across the studies, grade of evidence was low for balance, moderate for speed and function outcomes, and high for community participation. However, it is important to note that grading was done on few numbers of studies in each outcome. Conclusions: The summary of findings suggests positive and statistically significant effects (p<0.05) of VR treadmill training compared to other interventions on gait speed, dynamic balance skills, function and participation directly after training. However, the effects were not sustained at follow up in two studies (2 weeks-1 month) and other studies did not perform follow up measurements. More RCTs with larger sample sizes and higher methodological quality are required to examine the long term effects of VR treadmill effects on function independence and community participation after stroke, in order to draw conclusions and produce stronger robust evidence.

Keywords: virtual reality, treadmill, stroke, gait rehabilitation

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Authors: Ram Chandra Sah

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Few years back, naturally a very beautiful country Nepal was facing a lot of problems related to the practice of open defecation (having no toilet) by almost 98% people of the country. Now, the scenario is changed. Government of Nepal set the target of achieving the situation of basic level sanitation (toilets) facilities by 2017 AD for which the Sanitation and Hygiene Master Plan (SHMP) was brought in 2011 AD with the major beauty as institutional set up formation, local formal authority leadership, locally formulated strategic plan; partnership, harmonized and coordinated approach to working; no subsidy or support at a blanket level, community and local institutions or organizations mobilization approaches. Now, the Open Defecation Free (ODF) movement in the country is at a full swing. The Sanitation and Hygiene Master Plan (SHMP) has clearly defined Total Sanitation which is accepted to be achieved if all the households of the related boundary have achieved the 6 indicators such as the access and regular use of toilet(s), regular use of soap and water at the critical moments, regular practice of use of food hygiene behavior, regular practice of use of water hygiene behavior including household level purification of locally available drinking water, maintenance of regular personal hygiene with household level waste management and the availability of the state of overall clean environment at the concerned level of boundary. Nepal has 3158 Village Development Committees (VDC's) in the rural areas. Amarapuri VDC was selected for the purpose of achieving Total Sanitation. Based on the SHMP; different methodologies such as updating of Village Water Sanitation and Hygiene Coordination Committee (V-WASH-CC), Total Sanitation team formation including one volunteer for each indicator, campaigning through settlement meetings, midterm evaluation which revealed the need of ward level 45 (5 for all 9 wards) additional volunteers, ward wise awareness creation with the help of the volunteers, informative notice boards and hoarding boards with related messages at important locations, management of separate waste disposal rings for decomposable and non-decomposable wastes, related messages dissemination through different types of local cultural programs, public toilets construction and management by community level; mobilization of local schools, offices and health posts; reward and recognition to contributors etc. were adopted for achieving 100 % coverage of each indicator. The VDC was in a very worse situation in 2010 with just 50, 30, 60, 60, 40, 30 percent coverage of the respective indicators and became the first VDC of the country declared with Total Sanitation. The expected result of 100 percent coverage of all the indicators was achieved in 2 years 10 months and 19 days. Experiences of Amarapuri were replicated successfully in different parts of the country and many VDC's have been declared with the achievement of Total Sanitation. Thus, Community Mobilized Total Sanitation Movement in Nepal has supported a lot for achieving a Total Sanitation situation of the country with a minimal cost and it is believed that the approach can be very useful for other developing or under developed countries of the world.

Keywords: community mobilized, open defecation free, sanitation and hygiene master plan, total sanitation

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Authors: Karmela Palma Samson

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In recent years, there has been a growing interest in the implementation of Environmental, Social, and Governance (ESG) frameworks in private organizations. The COVID-19 pandemic and increasing global environmental concerns have further highlighted the importance of ESG practices in businesses. To be effective, the development and sustainability of ESG implementation require specific organizational functions. One such function is Organization Development (OD). This study aims to identify the roles of OD in the development, monitoring, and evaluation of ESG in private organizations. The role of OD in sustaining ESG implementation in private organizations was analyzed in this study. Qualitative research was conducted, which included interviews with OD practitioners to understand their role and challenges in maintaining ESG programs and initiatives. The study found that OD practitioners have low participation in managing ESG programs, initiatives, and indicators. However, the study also revealed that the OD function is crucial for the development, monitoring, and evaluation of ESG implementation in private organizations. In essence, the study highlights the importance of the OD function in ensuring the success of ESG implementation in private organizations. With their expertise in organizational development, OD practitioners can contribute significantly to the development, implementation, and evaluation of ESG initiatives. Therefore, private organizations should involve their OD departments in ESG implementation to ensure that they are sustainable, effective, and aligned with their organizational goals.

Keywords: ESG, organization development, private sector, sustainability

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Authors: R. Chedid, R. Ghajar

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Lebanon electricity crisis continues to escalate. Rationing hours still apply across the country but with different rates. The capital Beirut is subjected to 3 hours cut while other cities, town and villages may endure 9 to 14 hours of power shortage. To mitigate this situation, private diesel generators distributed illegally all over the country are being used to bridge the gap in power supply. Almost each building in large cities has its own generator and individual villages may have more than one generator supplying their loads. These generators together with their private networks form incomplete and ill-designed and managed microgrids (MG) but can be further developed to become renewable energy-based MG operating in island- or grid-connected modes. This paper will analyze the potential of introducing MG to help resolve the energy crisis in Lebanon. It will investigate the usefulness of developing MG under the prevailing situation of existing private power supply service providers and in light of the developed national energy policy that supports renewable energy development. A case study on a distribution feeder in a rural area will be analyzed using HOMER software to demonstrate the usefulness of introducing photovoltaic (PV) arrays along the existing diesel generators for all the stakeholders; namely, the developers, the customers, the utility and the community at large. Policy recommendations regarding MG development in Lebanon will be presented on the basis of the accumulated experience in private generation and the privatization and public-private partnership laws.

Keywords: decentralized systems, distributed generation, microgrids, renewable energy

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Authors: Maurice A. Duka, Leobel Von Q. Tamayo, Niño Carlo I. Casim

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The paucity of long-term measurements and monitoring of accurate water quality parameter profiles is evident for small and deep tropical lakes in Southeast Asia. This leads to a poor understanding of the stratification and mixing dynamics of these lakes in the region. The water quality dynamics of Sampaloc Lake, a tropical crater lake (104 ha, 27 m deep) in the Philippines, were investigated to understand how monsoon-driven conditions impact water quality and ecological health. Located in an urban area with approximately 10% of its surface area allocated to aquaculture, the lake is subject to distinct seasonal changes associated with the Northeast (NE) and Southwest (SW) monsoons. NE Monsoon typically occurs from October to April, while SW monsoon from May to September. These monsoons influence the lake’s water temperature, dissolved oxygen (DO), chlorophyll-α (chl-α), phycocyanin (PC), and turbidity, leading to significant seasonal variability. Monthly field observations of water quality parameters were made from October 2022 to September 2023 using a multi-parameter probe, YSI ProDSS, together with the collection of meteorological data during the same period. During the NE monsoon, cooler air temperatures and winds with sustained speeds caused surface water temperatures to drop from 30.9 ºC in October to 25.5 ºC in January, resulting in the weakening of stratification and eventually in lake turnover. This turnover redistributed nutrients from hypolimnetic layers to surface layers, increasing chl-α and PC levels (14-41 and 0-2 µg/L) throughout the water column. The fish kill was also observed during the lake’s turnover event as a result of the mixing of hypoxic hypolimnetic waters. Turbidity levels (0-3 NTU) were generally low but showed mid-column peaks in October, which was linked to thermocline-related effects, while low values in November followed heavy rainfall dilution and mixing effects. Conversely, the SW monsoon showed increased surface temperatures (28-30 ºC), shallow thermocline formations (3-11 m), and lower surface chl-α and PC levels (2-8 and 0-0.5 µg/L, respectively), likely due to limited nutrient mixing and more stable stratification. Turbidity was notably higher also in July (11-15 NTU) due to intense rainfall and reduced light penetration, which minimized photosynthetic activity. The SW monsoon also coincided with the typhoon season in the study area, resulting in partial upwelling of nutrients during strong storm events. These findings emphasize the need for continued monitoring of Sampaloc Lake’s seasonal water quality patterns, as monsoon-driven changes are crucial to maintaining its ecological balance and sustainability.

Keywords: seasonal water quality dynamics, Philippine tropical lake, monsoon-driven conditions, stratification and mixing

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Authors: Marie Fouet, Olivier Maire, Cécile Masse, Hugues Blanchet, Salomé Coignard, Nicolas Lavesque, Guillaume Bernard

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Exacerbated by global change, extreme climatic events such as atmospheric and marine heat waves may interact with the spread of non-indigenous species and their associated impacts on marine ecosystems. Since the 1970’s, the introduction of non-indigenous species due to oyster exchanges has been numerous. Among them, the Asian date mussel Arcuatula senhousia has colonized a large number of ecosystems worldwide (e.g., California, New Zealand, Italy). In these places, A.senhousia led to important habitat modifications in the benthic compartment through physical, biological, and biogeochemical effects associated with the development of dense mussel populations. In Arcachon Bay (France), a coastal lagoon of the French Atlantic and hotspot of oyster farming, abundances of A. senhousia recently increased, following a lag time of ca. 20 years since the first record of the species in 2002. Here, we addressed the potential effects of the interaction between A. senhousia invasion and heatwave intensity on ecosystem functioning within an intertidal mudflat. More precisely, two realistic intensities (“High” and “Severe”) of combined marine and atmospheric heatwaves have been simulated in an experimental tidal mesocosm system onto which naturally varying densities of A. senhousia and associated benthic communities were exposed in sediment cores collected in situ. Following a six-day exposure, community-scale responses were assessed by measuring benthic metabolism (oxygen and nutrient fluxes) in each core. Results show that besides significantly enhanced benthic metabolism with increasing heatwave intensity, mussel density clearly mediated the magnitude of the community-scale response, thereby highlighting the importance of understanding the interactive effects of environmental stressors co-occurring with non-indigenous species and their dependencies for a better assessment of their impacts.

Keywords: arcuatula senhousia, benthic habitat, ecosystem functioning, heatwaves, metabolism

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Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

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Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

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Authors: Ali Ashtiani, Hamid Shirazi

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This paper reviews the status of existing practice and research related to measuring pavement cracking and using crack density as a pavement surface evaluation protocol. Crack density for pavement evaluation is currently not widely used within the airport community and its use by the highway community is limited. However, surface cracking is a distress that is closely monitored by airport staff and significantly influences the development of maintenance, rehabilitation and reconstruction plans for airport pavements. Therefore crack density has the potential to become an important indicator of pavement condition if the type, severity and extent of surface cracking can be accurately measured. A pavement distress survey is an essential component of any pavement assessment. Manual crack surveying has been widely used for decades to measure pavement performance. However, the accuracy and precision of manual surveys can vary depending upon the surveyor and performing surveys may disrupt normal operations. Given the variability of manual surveys, this method has shown inconsistencies in distress classification and measurement. This can potentially impact the planning for pavement maintenance, rehabilitation and reconstruction and the associated funding strategies. A substantial effort has been devoted for the past 20 years to reduce the human intervention and the error associated with it by moving toward automated distress collection methods. The automated methods refer to the systems that identify, classify and quantify pavement distresses through processes that require no or very minimal human intervention. This principally involves the use of a digital recognition software to analyze and characterize pavement distresses. The lack of established protocols for measurement and classification of pavement cracks captured using digital images is a challenge to developing a reliable automated system for distress assessment. Variations in types and severity of distresses, different pavement surface textures and colors and presence of pavement joints and edges all complicate automated image processing and crack measurement and classification. This paper summarizes the commercially available systems and technologies for automated pavement distress evaluation. A comprehensive automated pavement distress survey involves collection, interpretation, and processing of the surface images to identify the type, quantity and severity of the surface distresses. The outputs can be used to quantitatively calculate the crack density. The systems for automated distress survey using digital images reviewed in this paper can assist the airport industry in the development of a pavement evaluation protocol based on crack density. Analysis of automated distress survey data can lead to a crack density index. This index can be used as a means of assessing pavement condition and to predict pavement performance. This can be used by airport owners to determine the type of pavement maintenance and rehabilitation in a more consistent way.

Keywords: airport pavement management, crack density, pavement evaluation, pavement management

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Authors: Scarlet Tabot Enanga Longsti

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Community-Based Health Insurance (CBHI) schemes have been proposed as a possible means to achieve affordable health care in low-and lower-middle-income countries. The existing evidence provides mixed results on the impact of CBHI schemes on healthcare utilisation and out -of-pocket payments (OOPP) for healthcare. Over 900 CBHI schemes have been implemented in underdeveloped countries, and these schemes have undergone different modifications over the years. Prior reviews have suggested that different designs of CBHI schemes may result in different outcomes. Objectives: This review sought to determine the interventions that affect the impact of CBHI schemes on OOPP and health service utilisation. Interventions in this study referred to any action or modification in the design of a CBHI scheme that affected the impact of the scheme on OOPP and/or healthcare utilization. Methods: Any CBHI study that was done in a lower middle-income country, that used an experimental design, that included OOPP or health care utilisation as outcome variables, and that was published in either English or French was included in this study. Studies were searched for in MEDLINE, Embase, CINAHL, EconLit, IBSS, Web of Science, Cochrane Library, and Global Index Medicus from July to August 2023. Bias was assessed using Joanna Brigs Institute tools for quality assessment for randomized control trials and quasi experimental studies. A narrative synthesis was done. Results: 12 studies were included in the review, with a total of 69 villages, 13,653 households, and 62,786 participants. Average premium collection was 4.8 USD/year. Most CBHI schemes had flat rates. The study revealed that a range of interventions impact OOPP and health care utilisation. Five categories of interventions were identified. The intervention with the highest impact on OOPP and utilisation was “Audit visits”. Next in line came external funds, training scheme workers, and engaging community leaders and village heads to advertise the scheme. Free healthcare led to a significant increase in utilisation of health services, a significant reduction in Catastrophic health expenditure, but an insignificant effect on OOPP among insured compared with uninsured. Conclusions: Community-Based Health Insurance could pave the way for Universal Health Care in low and middle-income countries. However, this can only be possible if careful thought is given to how schemes are designed. Due to the heterogeneity of studies and results on CBHI schemes, there is need for further research for more effective designs to be developed.

Keywords: community based health insurance, developing countries, health service utilisation, out of pocket payment

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