Marc Bosonkie, Benito Kazenza, Rawlance Ndejjo, Marie‐Claire Muyer · 10 authors
Background: The rapid spread of COVID-19 forced governments to urgently implement non-pharmaceutical measures to stop the surge. These restrictions disrupted the provision of nutrition services. This study identified challenges faced by nutrition services using the six components of the health system and preventive strategies that can strengthen nutrition interventions during future outbreaks. Methods: A multiple-case qualitative study was carried out. Purposive sampling was used for recruitment of participants. 57 key informants were selected based on their role in the Nutrition sector at different levels of the health pyramid. The interview guide incorporated nutrition leadership, financing, workforce, infrastructure and commodities, service delivery and information system. Each topic had subtopics on challenges and adaptations. All transcripts were exported to Atlas Ti v22, and thematic analysis was conducted. Results: Initially excluded from the national COVID-19 response, nutrition services were later integrated through advocacy by the National Nutrition Program. Despite limited funding, the government maintained support, and health workers adapted with flexible staffing approaches. Commodity shortages, including Ready-to-Use Therapeutic Food, led to the use of locally produced substitutes. Movement restrictions and fear of infection disrupted essential services such as growth monitoring and immunization. To sustain access, mitigation strategies were implemented, including tailored education, modified weighing methods, and decentralized care. Key innovations included rapid registration with anthropometric protocols, additional service points for child health activities, double-weighing scales to reduce contact, crowd control during Growth Monitoring Promotion, community-based service delivery, and improved digital integration. Conclusions: COVID-19 disrupted all pillars of nutrition services in the DRC but also spurred innovation. Institutionalizing adaptive strategies, securing sustainable funding, and supporting local Ready-to-Use Therapeutic Food production are essential to strengthen resilience and ensure continuity of nutrition services in future health emergencies.
Mick Lennon MACHADO, Cristine Garcia Gabriel, Francisco de Assis Guedes de Vasconcelos
ABSTRACT Objective This study analyzes the results of evaluative research on the Brazilian Food and Nutritional Security System. Method Was conducted a scoping review by collecting information from four bibliographic databases: Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS), National Library of Medicine (MEDLINE/PubMed), and Web of Science. Three researchers systematically selected the studies and extracted data. The researchers categorized the studies included according to an evaluative approach to the topics of financing, social participation, decentralization and government management, and monitoring and evaluation. Results Were found 1,987 references, 17 of which were selected for analysis. It is presented the evaluation of the System and of its public policy as a developing field permeated by different types of research and methods and which needs to be better qualified in relation to its theoretical and methodological approaches. The results and recommendations of the studies analyzed point out important elements to guide decision-making in relation to the System and its public policy. Conclusion In view of the recent weakening of the governance structure of this public policy at a national level, this study contributes to the debate on food and nutritional security and its reintegration into the Brazilian governmental agenda.
Yusuf Hassan Wada, Kenneth Okoineme, Jennifer Anyanti, Dayyabu Yusuf · 7 authors
People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.
BACKGROUND: In the homeless population, barriers to housing and supportive services include a lack of control or access to data. Disparate data formats and storage across multiple organizations hinder up-to-date intersystem access to records and a unified view of an individual's health and documentation history. The utility of blockchain to solve interoperability in health care is supported in recent literature, but the technology has yet to be tested in real-life conditions encompassing the complex regulatory standards in the health sector. OBJECTIVE: This study aimed to test the feasibility and performance of a blockchain system in a homeless community to securely store and share data across a system of providers in the health care ecosystem. METHODS: We performed a series of platform demonstrations and open-ended qualitative feedback interviews to determine the key needs and barriers to user and stakeholder adoption. Account creation and data transactions promoting organizational efficiency and improved health outcomes in this population were tested with homeless users and service providers. RESULTS: Persons experiencing homelessness and care organizations could successfully create accounts, grant and revoke data sharing permissions, and transmit documents across a distributed network of providers. However, there were issues regarding the security of shared data, user experience and adoption, and organizational preparedness for service providers as end users. We tested a set of assumptions related to these problems within the project time frame and contractual obligations with an existing blockchain-based platform. CONCLUSIONS: Blockchain technology provides decentralized data sharing, validation, immutability, traceability, and integration. These core features enable a secure system for the management and distribution of sensitive information. This study presents a concrete evaluation of the effectiveness of blockchain through an existing platform while revealing limitations from the perspectives of user adoption, cost-effectiveness, scalability, and regulatory frameworks.
Blockchain technology has a potential to address many of the food safety challenges facing the world today. Some of the most promising blockchain applications developed to data have been in the food supply chains.
For countries looking to implement multisectoral nutrition plans, it is critical to understand what works and how programs should be delivered and scaled-up in each context. Programs can learn from each other on how to adapt to new information, evidence and events related to scaling-up and district stakeholders can play important roles in implementation of this multisectoral plan. As part of "Pathways-to-Better Nutrition" (PBN) case study conducted by USAID/SPRING Project, this research set out to explore district leaders' perceptions of the nutrition situation, programs and opportunities for integration. Qualitative data were collected through key-informant interviews and focus group discussions. Thirty-five district and local leaders belonging to district and sub-county multisectoral nutrition committees in Kisoro and Lira were interviewed. Grounded Theory Approach was used to identify themes for coding and key domains included: learning, adoption and evidence of scale-up; adoption of innovations/interventions to local context, financing of nutrition-sensitive activities and long-term planning. Additionally, quantitative data collected by Feed the Future Innovation Lab for Nutrition were analyzed in each of the districts to provide nutrition snapshots. Malnutrition in the study districts was worse than the national average for stunting, anemia and women's underweight. The majority (91%) of respondents were not familiar with these nutrition statistics. Both study areas have formed nutrition multisectoral working groups (District Nutrition Coordinating Committees) and have developed management structures to implement interventions. Government stakeholders from every nutrition-sensitive sector referred to the lack of clear government programs that support nutrition directly in local policy environment. Key agricultural-related programs are focusing on wealth creation, value-addition or increasing agricultural productivity without nutrition lens (not "nutrition sensitive"). Nutrition is not on the 'list' of key priorities of district health departments unlike HIV/AIDS, malaria or sexual reproductive health. About 69% respondents believe they lack operational capacities and soft-power skills to design, implement and manage nutrition interventions such as leveraging of resources and being able to convey evidence. The understanding of "Scaling-up Nutrition" also differed by respondent, and this has resulted in different goals and measurements. Challenges related to nutrition financing were also noted, including fiscal decentralization, use of Output-Based Financing mechanisms, limited flexibility to re-allocate funds for nutrition, and lack of standard reporting procedures or implementation strategy. Efforts to address malnutrition need to be multisectoral, coupled with increased coordination of different sectors and ministries for sustained impact on nutrition outcomes.
Sascha Lamstein, Amanda Pomeroy–Stevens, Patrick Webb, Eileen Kennedy
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also explores the benefits of applying a systems lens to understand the dynamic, enabling processes of the policy cycle-from research to knowledge and ultimately action-and to provide more dynamic and accurate information for nutrition advocacy and evidence-based decision-making. It concludes with key findings from the 5 country-level studies included. Several important themes emerge: the egregious gap in human resources needed for effective nutrition actions in most low-income settings, the value of research on bottlenecks and successes, and the need for routine monitoring of national policies and plans to measure their effectiveness in achieving both their own stated goals and global sustainable development goals. Reviewing these studies together provides a path forward in building stronger, evidence-based multisectoral nutrition policies and supporting implementation of the nutrition activities included within them.
For decades, governmental public health in the united States has been relegated to operating at the margins of the country's massive healthcare system that drives nearly 20% of the uS economy.1 Further buffeted in recent years by a variety of external forces (including the 2008 economic recession, shifting demographics, a high and complex population burden of chronic disease, and a rapidly changing health care delivery system), public health leaders and policymakers increasingly recognize that the existing practice models are no longer adequate for the task of protecting and promoting the public's health.2 put simply, uS public health risks moving from being marginalized to becoming irrelevant if public health practice is not transformed.the challenges embedded in changing public health practice are multiple, and are made more complex by the decentralized structure of public health in the united States. public health here is a federated enterprise that includes national entities such as the Center for Disease Control and prevention, the Food and Drug Administration, and others; state and local governmental health departments; non-governmental organizations at the national, state, and community levels that are organized around single or multiple health-related issues; and public and private colleges and universities that provide education and training to the multiple disciplines making up the public health workforce. National study committees convened by the National Academy of Science's institute of Medicine over the past 30 years3-5 have consistently found the uS public health system to be in a state of disarray: misunderstood by elected policymakers and the general public; under-resourced in financial, technological, and workforce spheres; and highly variable in practice and services provided by over 2500 state and local governmental public health departments.For more than 20 years, the robert Wood Johnson Foundation (rWJF) has made significant investments in advancing public health in the united States. this includes multi-million dollar, flagship investments in public health accreditation and in public health systems and services research, with both efforts broadly directed toward improving the quality and impact of public health practice. it also includes more recent, and more narrowly concentrated, investments in engaging public health leaders in focused dialogues on critical operational issues as well as on more aspirational strategic thinking about how to catalyze and support transformational change in public health practice. three current examples of these strategic investments include:1. Building consensus around a set of core and foundational public health capabilities and services;2. developing an aspirational vision for uS public health in 2030; and3. identifying leadership and educational preparation needed to prepare the public health workforce of the future.Foundational Capabilitiesrecognition of the significant variability in the type, amount and financing of public health services led the institute of Medicine in 2012 to call for a '... minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without...'.5 through funding a public Health Leadership Forum (pHLF), rWJF convened a diverse group of federal, state, and local public health leaders and stakeholders in April 2013 to review this recommendation and operationalize it. over the course of the next nine months, the group developed consensus around a foundational capabilities and services framework6 (see Figure 1) and operationalized them with enough specificity that a costing model is now being developed. the framework is being systematically vetted with the broader uS public health community by way of presentations at multiple conferences, webinars, and social media. once vetted, it is hoped that the foundational capabilities and services framework will be utilized by state, local, and federal policymakers and result in increased resources for public health while decreasing variability in practice and, ultimately, improve population health outcomes. …
Childhood malnutrition encompasses a plethora of nutritional disorders that include stunting, underweight, wasting, severe acute malnutrition (SAM), and micronutrient deficiency disorders. Overweight and obesity, at the other end of the nutritional spectrum, are also manifestations of childhood malnutrition. Nearly 24 million children (younger than 5 years) worldwide experience SAM. The vast majority is located in Africa and Asia (8 million are in India alone). A child with SAM is 10 times more likely to die than a well-nourished child. SAM is one of the top 3 nutrition-related causes of death in children younger than 5 years. Estimates of deaths directly attributable to SAM varied from 0.5 to 2 million annually. Moderate and severe child malnutrition account for 40% to 50% of all deaths in children younger than 5 years. If the United Nations Millennium Development Goals (http://www.un.org/millenniumgoals) of reducing children malnutrition and mortality by 50% by 2015 are to be met, SAM needs to be prevented and controlled effectively. UN SYSTEM (UNICEF-WHO-WFP) ACTIVITIES IN PREVENTION AND TREATMENT OF SAM Support countries with high levels of SAM to scale up coverage for treatment through community-based management of acute malnutrition (CMAM) Preventing acute malnutrition in children and women through increasing coverage of high-effect interventions (eg, micronutrients) Inpatient treatment is reserved for the smaller group that requires close medical monitoring and therapies that are exclusive to medical facilities: parenteral hydration, treatment of hypotension, shock, metabolic alterations (hypoglycemia, hypothermia), or severe infections Integrated management of PEM considers both inpatient and outpatient treatment of SAM; whenever possible outpatient treatment should be used based on the following advantages: Minimizes effect on family and requires limited health services support Simpler treatment: no food preparation is required, can be eaten directly Broad coverage: eliminates primary barriers to “scaling up” (need for doctors and health facilities) Active case finding relies on community outreach The support for using community-based treatment is also based on equal or lower mortality rates and reduced cost (US$∼450–∼$130/child).Policy formulation at country level is progressing rapidly; 95% countries have national guidelines/protocols for acute malnutrition as evidenced by: Visible policy documents and joint statements Increasing coverage and scaling-up of programs: 55 countries implementing CMAM; an additional 7 countries are in the planning stages. Integration of CMAM with other primary health progress in at least 50% to integrate activities: integrated management of childhood illness, infant and young child feeding, human immunodeficiency virus/acquired immune deficiency syndrome Increasing adherence to a comprehensive integrated approach into health system Global guidelines and training resources are available including incorporation of infant feeding orientation into trainings.Challenges encountered in the implementation of the CMAM include Weakness in existing intersectoral linkages; stronger links with food security and other sectors are required in support of long-term solutions and prevent short-term emergencies Unpredictable funding; most resources still derived from humanitarian response for acute emergencies averting multiyear planning Difficulties in setting up long-term supply plans to ensure that ready to use therapeutic food (RUTF) needs are met and buffer stocks are in place. Geographical distance of manufacturers from the final beneficiaries is a problem; however, proliferation of unreliable local suppliers with poor quality control systems is not the answer. UN SYSTEM ACTIVITIES IN PREVENTION AND TREATMENT OF SAM The WHO Electronic Library of Evidence for Nutrition Actions (eLENA) has been released (www.who.int/elena). This updated version of the site includes new nutrition intervention topics such as food supplementation for children with moderate acute malnutrition, vitamin D supplementation in infants, multiple micronutrient supplementation in pregnant women, and community-based feeding for the promotion of child growth. Updates of the eLENA site have been launched and include translations into the 5 official WHO languages. The Spanish site was launched during the World Health Assembly in May 2012 (www.who.int/elena/es). Updated guidelines on the integrated management of SAM in children are expected to be released in the upcoming edition of eLENA. The Global Database on the Implementation of Nutrition Action is a complementary Web-based tool in which governments and organizations can upload and share information on their nutrition activities. The Global Database on the Implementation of Nutrition Action will have a user-friendly interface with interactive maps, lists, and fact sheets that show what is being done where, when, with whom, why, and how to scale up and improve nutrition. Users are invited to continue to upload nutrition action information via the online form at www.who.int/nutrition/gina. CHALLENGES FOR HEALTH PROFESSIONALS CONCERNED WITH GASTROINTESTINAL DISEASES AND NUTRITION IN ADDRESSING SAM Clearly, there is a need for all concerned parties to join forces; pediatricians and especially those with interest in gastrointestinal (GI) diseases and nutrition have an important role to play. Key challenges ahead and potential approaches in addressing them are summarized in the next section. Lack of political commitment: Nutrition is often a low priority on the political agenda resulting in limited funding or in some cases no secure budget allocation being made. SAM in many cases is not even recognized as a health problem (not included in surveillance systems). Health professionals should also be strong in advocacy efforts and lead the battle against SAM calling the attention of all concerned parties, not only on moral grounds but also as a key investment for national development. The implementation of known solutions requires a strong delivery system, such as infant and young child feeding. Thus, a well-supported health care service with broad coverage is fundamental, particularly in hard-to-reach areas and for population groups living in poverty or emergency conditions. Resistance of some governments to use imported ingredients, that is, RUTF or other costly supplies, limits implementation of CMAM programs in some areas of the world. The concerns are commonly based on sustainability and having to depend on imported commodities. These can be circumvented by using local ingredients and/or local blending of ingredients depending on circumstances. The appropriate design and effective implementation of CMAM requires local capacity to design, implement, and evaluate programs. Limited local capabilities impede progress in controlling and preventing malnutrition in many countries. The effectiveness of CMAM program requires local institutional capacity to ensure the delivery of a comprehensive package of services in emergencies (CMAM and micronutrients); in addition, information needs to be collected and reported to assess cost-effectiveness of the interventions. Successful sustained control of SAM requires intersectoral linkages beyond health; at the very least, they should include agriculture (food and nutrition security), water and sanitation, women's and children rights, community participation and empowerment. Creating sustainable livelihoods allows communities to meet their basic needs. Only then can governments be held accountable and responsible in addressing the social and economic determinants of SAM. Sustained funding for activities, programs, development of institutional and human capacity is fundamental to avert acute emergencies. Predictable medium- and long-term funding and multiyear planning are essential to prevent malnutrition in all its forms and avert the consequences on human and social development. Long-term supply to ensure that raw materials to produce RUTF are met and buffer stocks are in place and available to cover local needs. This requires appropriate quality control and distribution systems. Systematic collection of local, regional, and national data collection and information systems should be in place to guide CMAM activities, map SAM, and focus efforts on most-affected areas. Information flow from field to national level should be established; consistent use of WHO reference growth standards should be used within and between countries, defining common performance indicators for regional- and country-level reports. This report is a short account of present efforts in addressing SAM; what we do or fail to accomplish in the next few years will have major significance if we are to achieve the millennium development goals 1 and 4. Halving hunger by 2015 most likely will not be achieved on a global basis; however, with appropriate support, this may be achieved by many countries in Africa and southeast Asia. Similarly, reducing by two-thirds the mortality of children younger than 5 years unless we make this a global priority for action and do not leave this to action by local governments that may or may not see this as a top priority. It is time that we consider child health and well-being a global priority subject to commitments by global governance; sooner or later we must face that “children's needs cannot be postponed.” We must act now to secure their basic needs—the future of humanity is at stake. All JPGN readers are concerned with malnutrition in children because most diseases of the GI tract have a negative effect on nutrition. Because they are common all over the world, essentially as a consequence of infection, they represent a major cause of malnutrition. Malnutrition, A Risk to All Children and Humanity Nutrition is essential for all life to be perpetuated through reproduction. Childhood is the period in which growth and psychosocial development are supported by use of food through metabolic processes genetically determined. Malnutrition is a generic term that covers the results of any deviation that impairs growth and development. It may be so severe that it may remove the life of the child. Most often the child recovers after proper treatment, but in too many children, it will last for years. Many girls reach reproductive age in poor nutritional condition. The millions of children born to malnourished women are more likely to face cognitive impairments, short stature, lower resistance to infections, and a higher risk of diseases throughout their lives, thus perpetuating the cycle of malnutrition. Select Realistic Target At the global scale, the most prevalent situation is deficit rather than abundance in food availability or food use or both, for example, as a consequence of GI disorder, infectious disease, or low birth weight (LBW). According to UNICEF, 1 in 4 children in the developing world are underweight. Because pediatricians are facing such a disaster, it is difficult to imagine what can be done to solve it; however, by targeting specific population, it may be possible to envisage proper treatment. First, it is important to define the different states of malnutrition. Malnutrition may be the results of general or selective food deprivation, essentially iron, iodine, zinc, and vitamin A. The most common clinical conditions are underweight, stunting, and wasting. All of these conditions occur in different context that need to be analyzed. Second, it is important to identify the regions of the world that need context-specific approaches. More than 10 million children die each year, most from preventable causes and almost all in poor countries. Six countries account for 50% of worldwide deaths in children younger than 5 years, and 42 countries for 90%. The causes of death differ substantially from one country to another. A better understanding of child health epidemiology could contribute to more effective approaches to saving children's lives (1). Severe Acute Malnutrition SAM is defined by an extremely low weight for height, by visible severe wasting, or by the presence of nutritional edema. Until the end of the 20th century, the median under-5 case-fatality rate for SAM typically ranges from 30% to 50%. It was reduced substantially (typically <5%) when physiological and metabolic changes were taken into account and a standardized protocol was initiated (2). The use of F100 as a milk powder reconstituted with water to obtain 100 kcal/100 mL was effective but its use was limited to medical structures. The RUTF was a major step in overcoming the limitation of F100 (3–5). In 1997, André Briend, who was the initiator of such treatment, conducted the first clinical trial in Tchad as a proof of concept. In 2005, in Niger, Médecins Sans Frontières treated at home 60,000 children with a success rate of 90%. Such a therapeutic approach is expected to save millions of children. Linear Programming One approach to prevent malnutrition and maintain healthy nutritional status is to use locally available food. However, many limits need to be taken into account, including food availability, composition, and cost, which must cover the nutrient recommendations for that population. Historically, such an approach was at on trial and The of nutrition has been with a tool The is The more a child a for example, the more or and such a is The for and and cost of the This is what can solve an program was then more user-friendly programs were for example, In a program was being and should be released more pediatricians and to proper recommendations that are as food rather than Such an approach could be used in many different in both and developing Childhood Malnutrition in Asia defined as the reference is the most common of childhood malnutrition and malnutrition. 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In children 5 years, million in southeast with million in all of Africa from which is nutritional in and 2005, 50% of age children in Asia vitamin A deficiency by a level deficiency has negative on growth and development to In children in Africa with 30% in southeast Asia being in southeast at high risk for deficiency are those with a of and of of deficiency is high in Asia Overweight and are the of the Overweight in childhood is defined as a can be defined as having a it has a primary childhood health problem in countries are also to see childhood as a of children in the and WHO regions were to be or by in in the and in southeast Asia A done on children a in of from in to in The of malnutrition and the from in children of Asia for Nutrition must be treated as a development agenda and to the in national policy formulation and is a major in many countries and needs attention for more as as and This has even more for countries such as which face by interventions should be up to reach These interventions include appropriate complementary feeding, micronutrient treatment of moderate acute malnutrition and SAM These interventions will not be interventions and in water and poverty and so on need to be at It is also to have programs such as social and sanitation, and interventions. 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It is important for children in developing countries to from to to and in The of nutrition of children is a of social and economic with a effect on to food and nutrition. The information available the health of a to a were as of and and in the of of living and social and poverty by the Children in a cost from the in the of infectious and malnutrition. The effect of child with infection, especially infection, is the In children of the population but for of for deficiency and of for other nutritional infections, with rates up to the of the population, with poor nutrition to produce a by poor especially of and perpetuating a cycle of and malnutrition to poverty first with lower birth up to 1 than in some and with the risk of which on was than the of the community in This is by growth in the first of In the century, 30% and of were the for weight and height, increasing to and by 24 of age At the of the century, infant mortality the poor times that of higher groups at and there is a deficit of years for these and 20th health with for infections, and severe nutritional and a however, from conditions to a situation that has but has of nutritional to and 40% of to are or increasing to almost during the years This problem in childhood with more likely to be or than higher social Increasing is with increasing 2 and metabolic which occur in up to of low social of poor are and experience higher and The causes of death those of low social living in poverty are and with standardized mortality rates for to and for and metabolic to times than higher groups now for of the between higher and lower social The from diseases of nutritional deficiency to diseases of is to the nutritional experience of children, with nutritional experience into long-term health of poverty and food and food quality have resources to food and poor to a is increasing More important is in nutrition and by both and which with childhood malnutrition is with later and its long-term These nutritional of and metabolic to the in which with food. These represent major potential of intervention essential for health and well-being at the population are no solutions to the by children. The solutions are not and healthy are are they to low but common to many other and groups of the and to their of is as is and the role of women, social and and These may from nutritional and but advocacy a of and in The 2 of Malnutrition The health of childhood are and attention In countries, food not have the and it too is a global that in and countries, with for long-term health and development. In million children in poverty and million in more than one of children and are or food and are as health there is increasing there is between these conditions. children are often from in food in children who face food are more likely to report hunger Children who with hunger are more likely to be experience and have a higher of and of key and are more likely to have and The and long-term consequences of and are and include psychosocial and joint and their long-term obesity, food and hunger are often in even in in which other indicators of poverty are food programs: than of the children for a or a and of children in a program Risk for food include or the poverty children by and those located in or areas. communities at high risk for as is more prevalent those who are poor and for this of these 2 there is no some are in and have limited to healthy which to with of low cost but food. 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This article presents a conceptual framework for analyzing societal responses to women battering in Israel. The model of policy analysis consisted of three specific dimensions namely: 1) descriptive-operational; 2) analytic interpretive; and 3) chronological. Allocation provision delivery and financing of interventions with the abused Israeli women and their families were conducted from 1986 to 1988 through telephone surveys. Data indicate that due to strong religious influences on family life and political factors poor services were provided to abused women. The influence of social welfare in response to women battering were as follows: 1) intervention in woman battering was specific rather than universal; 2) services have been decentralized since their inception; and 3) intervention has been influenced by a collectivist residential orientation to welfare services. Furthermore government agencies and nongovernmental agencies provide only limited services for physically abused women.
:The development and spread of Acquired Immunodeficiency Syndrome (AIDS) in American urban areas is challenging established policy making structures and patterns in a variety of ways. AIDS is forcing urban policymakers to engage in unusual efforts at large and nonincremental change while possessing relatively little understanding of the ultimate nature and course of the disease. A variety of uncertainties exist, involving the future scope and development of AIDS, current and future treatment costs, legal and administrative responsibilities, workplace concerns, education efforts, financing methods, and political effects. As a consequence, those making AIDS policy must rely upon what Jones (1984) terms ambitious decisionmaking styles. Successful control of AIDS will require decentralized policymaking centered on experimental efforts in each urban area confronted with the disease. Given the wide range of uncertainties regarding the nature of AIDS and effective policy measures, it is unlikely that a truly national AIDS policy will be established in the immediate future.