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Caregiver influences on child psychological adjustment following trauma; a longitudinal study of a high adversity South African population
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
"Children who experience very frightening or traumatic events (such as car accidents, assaults, serious injuries) are vulnerable to developing posttraumatic stress disorder (PTSD) and other psychological difficulties following their experiences. Such problems can be extremely distressing, and affect a significant proportion of trauma exposed children. One factor that has the potential to influence such outcomes is the informal support that children receive from their parents/caregivers posttrauma. In research we have conducted in the UK, we found that certain aspects of caregiver responses can have an impact upon children's psychological recovery following trauma. In particular, where caregivers encourage ways of coping in children that allow them to avoid being reminded of the trauma, and/or talk to children about what happened in a way that emphasizes high levels of threat associated with the trauma, children are more likely to experience persistent symptoms of PTSD. These caregiver responses may influence child symptoms as a consequence of children themselves then making more negative appraisals in relation to what happened, and by influencing child coping behaviours. We propose to extend our UK work to the study of a high adversity international population. To date, only a small proportion of PTSD research has been conducted in low-and-middle-income countries (LMICs). This omission is important, as LMIC children may be particularly vulnerable to trauma exposure for a variety of reasons (e.g., poverty, crime, regional conflict). It is essential to establish whether psychological and social processes that have been linked to child PTSD in lower risk settings still apply in contexts where levels of ongoing threat and the likelihood of exposure to recurrent traumas are high. In particular, although we know that caregiver support is a key predictor of child psychological recovery following trauma in high income countries, our understanding of the elements of support that can help children from high adversity, lower income contexts is almost non-existent. This is important, as such children are almost certain to rely on such informal support following trauma exposure, due to limited access to formal psychological services. To address this critical gap in our knowledge, we plan to study the psychosocial factors that contribute to PTSD in a group of children (aged 8-16 years) from a deprived community in South Africa, in which rates of serious trauma exposure are extremely high. We will recruit 250 children who have experienced trauma within 2 weeks following the event. We measure how caregivers provide support, as well as children's initial levels of symptoms. We will then follow-up children and caregivers 3 months and 6 months later, measuring their PTSD symptoms. We will examine whether there are particular elements of caregiver support in the aftermath of trauma that are associated with higher or lower levels of symptoms in children further down the line. We we also will test whether caregiver influences operate via changing key psychological processes (trauma appraisals, coping) in the child, and will take account of caregivers' own trauma-related distress in our study. In addition to helping us to understand what kind of social support is best for children who experience trauma, our project will provide much needed information about the development of PTSD in children from high adversity, low income communities. This is important: at the moment we are lacking even basic information about risk of PTSD in the acute aftermath of trauma among such children, including the proportion who will initially develop this disorder following trauma, the window of time during which children may recover naturally following the event, and the proportion likely to experience persistent disorder and need intervention. This is a major barrier to developing screening and intervention programmes, which our study will be able to address. " COVID-19
Highlight: Identifying barriers to mental healthcare for civilians affected by protracted armed conflict in Colombia
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
"This will be the first project to identify invisible victims using innovative data-linkage between i) a nationally representative psychiatric epidemiological study (N=12k+) that used active case ascertainment in the general population, and; ii) data fromthe national mental health programme (N=1 million+), and the first to examine quality of care at the population level. We will use robust statistical analysis to identify: 1) social, health, and demographic drivers of being an invisible victim of conflict - who has conflict-related mental health needs but who never accesses services 2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related mental health needs who successfully access services 3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment access / outcome in women and girls All 3 aims address urgent national policy issues. Aim 3 was suggested, and most prioritised by, our panel of people with lived experience of the armed conflict who will continue to co-produce this project."
Sharing learning around the role of Community Health Workers in improving the resilience of health systems in Brazil and the UK
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
We want to build a strong partnership between Imperial College London and Fiocruz Brazil to enable reciprocal learning. Our first goal is to exchange knowledge and research on an effective and affordable healthcare model, the role of Community Health Workers (CHWs), which originated in Brazil. CHWs are a vital part of Brazil's health system, and played a significant role in improving public health over the last 30 years. Inspired by Brazil's success, the UK is now introducing CHWs and there are already 100 CHWs providing support to 20k households nationally. Important learning from the implementation in the UK can offer reciprocal benefit to Brazil, particularly regarding resources and skills, training around chronic disease and mental ill health and research. We want to make sure that as the UK adopts this model, it respects and learns from Brazil's experience and 'gives back' in terms benefits. Brazil's success offers valuable insights for the UK and the adoption of the CHWs is a rare example of 'reverse innovation'.(1) The term 'reverse' is testimony to the bias of lower income countries predominantly learning from high income countries. However, a more balanced knowledge exchange is possible. Brazil can benefit from the UK's experience of implementing their model, especially in dealing with issues like mental health and chronic diseases and how CHWs in Brazil could be trained and supported to deal with these growing issues. By working together, we can learn from each other and strengthen the CHW model in both countries. We plan to involve CHWs from both Brazil and the UK in this process, recognising their expertise and frontline experience. Our second goal is to collaborate on research about making health and social care systems more resilient to system shocks such as pandemics or natural disasters. Fiocruz is a world leader in applying Functional Resonance Analysis Method (FRAM) to study resilience in healthcare, in particular how CHWs in Brazil have impacted positively on resilience in the health system there by creating a more adaptable, community-focused approach. Unlike traditional resilience research, FRAM allows us to predict and test how systems work in the every day, not just in crises. We want to use these research methods to understand health system resilience better by applying this research to the UK, where our Brazilian colleagues can advance these methods by directly comparing systems with and without CHWs. In Brazil, CHWs are established as a fundamental part of the SUS and such comparisons are no longer possible in the same way. This collaboration has the potential to make a significant impact in both countries. Global challenges like climate change, future pandemics, and the growing demands on health and social care systems due to an ageing population will require global solutions. The CHW workforce could be a key part of addressing these challenges. This proposal is the foundation for building strong alliances between our teams and organizations in both countries. This includes developing joint funding proposals, research projects, accessible blue prints and toolbox kits and engaging with key stakeholders for reciprocal learning. We will organize roundtable discussions with senior leaders, community members, and academics from both countries to ensure support for scaling and sustaining this model, and to quickly turn research into practice.
UK investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria 2023-2025
UK - Foreign, Commonwealth Development Office (FCDO)
To tackle the immediate impact of the three most deadly infectious diseases – HIV/AIDS, tuberculosis and malaria – and put the international community on the right track to end the three diseases as epidemics by 2030.
Active Citizenship Through Inclusive Volunteering & Empowerment (ACTIVE) programme
UK - Foreign, Commonwealth Development Office (FCDO)
ACTIVE will increase local accountability, inclusion and reduce poverty by identifying and empowering the most vulnerable and marginalised people (especially women and girls, the young and people with disabilities) to lead and shape their own development. It will support vulnerable and marginalised people to take-action on issues important to them. It will strengthen civil society and build a culture of volunteerism and civic engagement whilst building the capacity of governments and service providers to respond to the demands of marginalised citizens.
Better Lives for Somali Women and Children
UK - Foreign, Commonwealth Development Office (FCDO)
To achieve UK's manifesto commitment of reducing preventable deaths, the Better Lives for Somali Women and Children will continue to respond to the health and nutrition needs of the Somali people. There will be a continued focus on delivering an essential package of health services. The programme will strengthen the Somali Health Authorities oversight of service provision, which will in turn promote local accountability and allow them increasingly to respond to the needs of their populations. This programme approach aims to support long term sustainability and state building that is part of the wider strategic agenda. There will also be a climate change mitigation component (ICF) within the programme.
Health Resilience Fund in Zimbabwe 2021-2025
UK - Foreign, Commonwealth Development Office (FCDO)
To support a resilient health system in Zimbabwe that is equipped to deliver quality sexual, reproductive, maternal, newborn, child and adolescent health and nutrition services.
HEALTH Systems Connect
UK - Foreign, Commonwealth Development Office (FCDO)
Official Development Assistance (ODA) Flag ODA (100% ODA) Title Health Systems Connect: NHS England Description The Programme aim is to provide posts and host governments with access to British health expertise through technical exchange with experts working across the UK’s health policy, planning and delivery ecosystem to support countries across the official development assistance (ODA) eligible FCDO network to achieve universal health coverage.
Middle East and North Africa Regional Humanitarian Response.
UK - Foreign, Commonwealth Development Office (FCDO)
This project will provide support to the MENA region to respond to crises in order to: Save lives and prevent suffering via humanitarian support, including to international partners. Facilitate the enabling environment of the humanitarian response in country, through close engagement with national authorities and humanitarian partners, and advocacy towards effective coordination. Maximise impact, promote UK leadership and strengthen bilateral relations with partner Governments.
Essential Services for Maternal and Child Health [Services Essentiels de Santé Maternelle et Infantile en RDC (SEMI)]
UK - Foreign, Commonwealth Development Office (FCDO)
To support essential maternal, child and infant health services to end preventable deaths in one of the poorest provinces in DRC and strengthen the health system at national and provincial level.
Support to the Palestinian Authority to Deliver Basic Services, Build Stability and Promote Reform in the Occupied Palestinian Territories (SSRP)
UK - Foreign, Commonwealth Development Office (FCDO)
To support the Palestinian Authority (PA) to meet the needs of the Palestinian people. Funding will enable around 25,000 young Palestinians with access to an education, provide up to 3,700 immunisations for children, and 185,000 medical consultations each year. This will help to build and strengthen the capacity of PA institutions through public financial management reform, and build stability in the region by preserving the two state solution.
Eliminating Lymphatic Filariasis in Africa ELFA
UK - Foreign, Commonwealth Development Office (FCDO)
The new FCDO Neglected Tropical Diseases NTDs programme ELFA is a £15m (ODA RDEL) programme contributing to the Reaching the Last Mile Fund (RLMF)
Tristan da Cunha Provision of Technical Assistance and Essential Infrastructure 2023 to 2026
UK - Foreign, Commonwealth Development Office (FCDO)
To enable the Administration of Tristan da Cunha to provide appropriate public services to meet the basic health, education, safeguarding and governance needs of the island community, through the provision of professional expertise and training.
Mozambique Demographic Transition - Waala - Programme
UK - Foreign, Commonwealth Development Office (FCDO)
To contribute to a more favourable enabling environment for the demographic transition in Mozambique, through coordinated action with others. The FCDO will use programming, evidence and diplomacy to influence decision-makers to increase investments towards cost-effective interventions that will accelerate changes in the population structure. These interventions will help young people to fulfil their potential by preventing unintended pregnancies and improving the literacy and numeracy skills among girls. The Government’s systems will be strengthened to include population issues in planning and budgeting. Over 130,000 unintended pregnancies will be averted resulting in 427,000 users of modern contraceptives. These investments should help to offset deteriorating human capital outcomes because of COVID-19.
South Sudan Health Pooled Fund Phase III
UK - Foreign, Commonwealth Development Office (FCDO)
To provide a government led effective health system that will deliver improved access to quality health services across seven states in South Sudan with a specific focus on reducing maternal and child mortality. The Health Pooled Fund (HPF3) will reduce maternal and under-five mortality rates in South Sudan, through (i) the delivery of a basic package of health and nutrition services; (ii) promoting community engagement in health as a public good and (iii) supporting local health systems stabilisation.
Building a Resilient Health System to End Preventable Maternal, New-born and Child Deaths in Ethiopia
UK - Foreign, Commonwealth Development Office (FCDO)
In line with Manifesto commitments and FCDO Ethiopia’s strategic business planning, this programme will help to prevent avoidable maternal, new born and child deaths and accelerate the fertility transition in Ethiopia by building the capacity of the health system to self-finance quality health services for all its citizens, without financial hardship by 2030. It builds upon the gains made and lessons learned from current and past health investments, moving beyond increasing access to health services by supporting efforts to . improve quality of care for better reproductive, maternal, new-born and child health (RMNCH) outcomes; . target more effectively the poorest and most vulnerable to drive health equity; •increase the health system’s capacity to respond to crises; and •reduce reliance on external actors for health financing and technical assistance as DFID prepares to exit from bilateral financial aid for health by 2025.
LAFIYA -UK Support for Health in Nigeria
UK - Foreign, Commonwealth Development Office (FCDO)
To save lives, reduce suffering and improve economic prospects for the poorest and most vulnerable in Nigeria through: i. Encouraging Government of Nigeria to increase resources invested in health (through advocacy, community accountability; and data to inform government prioritisation using a “delivery” approach, as used successfully in Pakistan) ii. Improving effectiveness and efficiency of public and private basic health services (through innovative financing mechanisms, strengthening health systems and working with private sector to deliver affordable health services for the poorest populations) iii. Reducing total fertility rate (through addressing social norms, demographic impact analysis, and support to family planning commodities and services).
Tonga: International Programmes Support
UK - Foreign, Commonwealth Development Office (FCDO)
Support for Tonga's capacity building, human rights, democracy, health and welfare and climate objectives. These objectives support the poverty alleviation aims of ODA and our Country Business Plan Goals.
International Programme Fund
UK - Foreign, Commonwealth Development Office (FCDO)
The International Programme Fund is designed to support programme activity aligning with the UK government's foreign policy in Angola. This includes, identifying, promoting, and delivering bilateral economic partnerships; working with partners to improve the situation in southern Angola, caused by food insecurity, drought, and climate change; promoting inclusive and sustainable development.
Umoyo Wathu Health System Strengthening Programme
UK - Foreign, Commonwealth Development Office (FCDO)
To reduce rates and inequalities in maternal, under-5 and new-born deaths; as well as reduce stunting in under-5s, by strengthening the quality and coverage of a package of essential health services through lower level district administration. The programme will increase the provision and uptake of quality, highly cost effective life-saving primary healthcare services provided free at the point of use, and so better protect the most vulnerable against the financial consequences of ill health. By 2028, the programme will contribute to reducing maternal mortality from 439 to 350 per 100,000 births; neonatal mortality from 27 to 22 per 1,000 live births; child mortality from 64 to 48 per 1,000 live births; stunting in children under five years of age reduced from 37% to 31%; and impact of communicable disease outbreaks and epidemics.
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