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Health systems research in fragile and conflict affected states: a qualitative study of associated challenges
Aniek Woodward1,
Kate Sheahan2,
Tim Martineau3 &
Egbert Sondorp4
High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges.
Guided by a purposely-selected steering group, this qualitative study collected respondents' perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited.
Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results.
This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts.
The World Bank estimates that two billion people worldwide reside in countries distressed by fragility, conflict and violence [1]. Fragile and conflict-affected states (FCAS) lag behind more stable contexts in meeting international health goals [2, 3]. Implementation of well-known health strategies and technologies proves even more difficult in FCAS than in other, equally poor but more stable countries [4]. FCAS typically have limited institutional capacity, often leading to weak health systems. Health systems research (HSR) needs to take this fragility into account in order to contribute to the development of policies and programmes that will improve health outcomes in the short and longer term [4,5,6].
Although definitions and classifications of fragile, conflict-affected, and post-conflict states vary in the literature and among development agencies, broad consensus defines a 'fragile state' as one that fails to maintain rule of law or perform functions essential to meeting the basic needs of its people, including poverty reduction [7,8,9]. Further, the extent and experiences of fragility vary greatly within FCAS [10]. Many, but not all, fragile states are affected by or emerging from conflict [7]. Conflict is both a precursor to and consequence of 'fragility' – a term increasingly used instead of 'fragile states' as it is regarded as less political. Conflict-affected countries often experience prolonged periods of relative stability, during which health system strengthening agendas emerge.
Researchers and donors have found HSR in FCAS to be a growing area of interest [11,12,13,14]. However, this area of research remains underdeveloped, partly because of its intrinsic challenges. While a recent evidence review of research on health interventions in humanitarian crises found a significant increase in papers on health systems from 2010 onwards, the quality of research was reported as "questionable", possibly due to the fact that it is conducted in "insecure and unpredictable environments" [15]. Along the same line, a donor report states that "measuring and managing results in FCAS raises specific practical challenges and some opportunities beyond those normally encountered in more effective states" [16]. In addition, there is some evidence regarding research challenges from papers on conflict and emergency situations, including ethical challenges [17,18,19,20,21], access to the field [22,23,24], security [20, 24], quality of data [15, 21, 25], in-country research capacity [24], and terminology issues [26, 27]. However, these challenges are generally subjective, based on opinions and experiences of these papers' authors, and they are not specific to HSR.
HSR, a complex and long-term endeavour, entails additional challenges. A better understanding of the challenges involved specifically in HSR in FCAS is essential in order to tackle them and to support and promote higher-quality research in such contexts.
This study consulted a broad range of stakeholders on their perceptions and experiences of the challenges involved in HSR in FCAS. Results presented here were part of a broader study undertaken to identify research needs in FCAS [13], which was led by the Thematic Working Group on Health Systems in Fragile and Conflict Affected States (from here on called TWG).Footnote 1
This larger study employed a qualitative descriptive approach using five different stages. The first two stages were used to consult on the challenges and are described here. Information on the other stages is published elsewhere in this journal [13]. Similar techniques have been used in prior research priority setting exercises [28,29,30].
The first stage involved the development of a steering committee (n = 30) and agreement on the methodological approach. Further details on the selection of the steering committee is found elsewhere [13]. The objectives of the second stage of this research were to develop an understanding of health systems research needs and challenges associated with conducting HSR in FCAS via an online survey and a face-to-face group discussion during the Third Global Symposium on HSRFootnote 2 in Cape Town on September 30, 2014. The aim was to consult a wide variety of participants with knowledge of and/or direct experience of HSR in FCAS.
The survey collected basic demographic information. It also elicited personal information such as how the participant heard about the survey, primary work context, experience working in FCAS, and involvement in HSR in FCAS. To facilitate development of the final survey tool, researchers conducted a pilot survey amongst a sub-section of the steering committee of the overall study and then made revisions based on the pilot survey results and participant feedback. Both the pilot and final survey (Additional file 1) were developed and distributed via the Bristol Online Survey tool, which is commonly used by universities in the United Kingdom and ensures participant anonymity.
All contactable people with at least a minimum expertise in health systems in FCAS were eligible to participate in the final survey. The aim was to obtain a sample of approximately 100 people, including a mixture of male and female respondents with a range of experiences (donors, policymakers, academics, international and local implementers) and from a variety of geographical areas (representing different continents and countries, including FCAS).
Researchers recruited respondents through three main channels, namely through (1) the study's steering committee recommended candidates (n = 177), (2) members of the Health and Fragile States NetworkFootnote 3 (n = 297) and ReBUILD ConsortiumFootnote 4 (n = 27) and (3) members of the TWG. The first two groups were asked to participate via an email invitation containing a brief description of the study and a hyperlink to the survey; the third group was invited with a link to the survey through a post on the TWG LinkedIn groupFootnote 5 page (which had 264 members, although there was likely a large overlap with those emailed). Figure 1 shows a flowchart of the recruitment and data generation process.
Participant recruitment and data generation process
The online survey was open for 2 weeks (October 14–28, 2014) to allow participants to complete it electronically at a private and convenient place. It elicited individual perspectives and did not ask people to respond on behalf of any organisation they work, or have worked, with. The survey, written in English, contained open-ended questions and took about 10–15 minutes to complete. Researchers sent two reminders during the 2 weeks to encourage participation.
At the symposium, the TWG led the group discussion, which formed one component of the project. During this session, a draft landscaping paper that focused on HSR in FCAS was presented. In addition, two research papers published in a special issue of Conflict and Health entitled "Filling the void: Health systems in fragile and conflict affected states"Footnote 6 were presented. Panellists and attendees then discussed health system research needs and the challenges of conducting such research in FCAS.
One author (AW) transcribed, anonymised and thematically analysed the recorded group discussion. The author also anonymised survey results and analysed quantitative data using Microsoft® Excel® for Mac 2011. Two authors (AW and KS) independently analysed qualitative survey data using thematic analysis with the support of qualitative data analysis software. AW used NVivo for Mac, QSR International Pty Ltd. Version 10, 2014, and KS used ATLAS.ti. version 7.5.11. Each coded the qualitative survey data using inductive descriptive coding [31]. Authors discussed emerging themes via Skype meetings. Both authors identified similar themes, and thus no reconciliation of differences was required.
The group discussion at the Health Systems Global conference included observations from four panellists and seven session attendees. Discussants, both female and male, represented different professional backgrounds, including academia, funding, non-governmental organisations (NGOs) and policy groups. Discussants did not specify countries of residence.
Sixty-one of 501 contactable and eligible candidates (12.2% response rate) completed the survey. Most (69%, n = 42) heard about the survey via an email invitation: 18% (n = 11) via the TWG LinkedIn group and 13% (n = 8) via another channel such as through a colleague. Overall, 59% of respondents were female and 41% were male, 43% worked in international implementation (e.g. international NGOs), 31% worked in academia (e.g. universities, research institutes), 16% worked in local implementation (e.g. government, local NGO), and 10% worked in funding (e.g. donors).
At the time of the survey, respondents resided in 28 countries, 15 of which were considered by respondents as fragile and/or conflict affected. Most respondents lived in the United Kingdom (12.1%), followed by Afghanistan (8.6%), Sierra Leone (8.6%) and the United States of America (8.6%). Among those with any experience working directly in fragile and/or conflict-affected states (93%), 8.1% had worked in Afghanistan, 7% in South Sudan, 5.8% in Sierra Leone, and 4.1% in Somalia. Respondents might have worked in more than one of these countries. Together, respondents had experience working in 56 different fragile and/or conflict affected countries. Figure 2 Footnote 7 shows the countries and areas in which respondents had worked. Respondents could list up to five countries. Those who had worked in more than five countries were encouraged to list those in which they had the most experience.
Countries in which survey respondents had professional experience
Most survey respondents (92%) felt that the contexts of FCAS are different from the contexts in states not considered fragile or conflict affected. Of those ever involved in HSR in fragile and/or conflict-affected states (45/61, 75%), almost all (98%) experienced challenges in gaining support for, conducting or applying their research.
The identified challenges fell under three broad thematic areas, namely (1) lack of appropriate support, specifically lack of long-term support and commitment, (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges, and lack of trust in the research process, and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results. Figure 3 provides an overview of these challenges as they commonly occur within the research process.
Main challenges encountered during health systems research in FCAS
Lack of appropriate support
Survey and discussion participants articulate a lack of organisational commitment to and support for HSR in FCAS.
First, HSR in FCAS is often regarded as a low priority. One survey respondent working in the academic sector in the United Kingdom noted that it is difficult "to convince key stakeholders of the importance of doing health systems research" in FCAS, particularly in post-conflict situations. Numerous respondents echoed this limited interest of key stakeholders such as national governments, international donors and academic institutions.
Second, it is challenging to secure appropriate funding for this area of research. A respondent working in international implementation in the Ukraine stated that "short funding cycles do not allow for much meaningful research" and that such short funding cycles make it difficult to discern whether research application has a sustainable impact on the health system. Similarly, discussants at the Cape Town Conference highlighted a lack of funds for comprehensive and longitudinal research in conflict-affected environments. Without long-term support and commitment, it is difficult to conduct meaningful HSR in FCAS. A respondent working in academia and in the funding sector in Iraq confirmed, "There are no proper resources, continuity, or commitment to maintain the research process in an effective and meaningful manner".
Besides limited support and commitment, which are critical to starting and maintaining the research process, the majority of challenges reported relate to the practicalities of conducting HSR in the complex contexts of FCAS. These are discussed below.
Complex local research environment
Respondents identified access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process as the key factors that present unique, specific and sizeable challenges to conducting HSR in FCAS.
Access constraints
Almost all respondents mentioned access constraints as a significant challenge to conducting research in FCAS. These include access to reliable data, the field and research participants.
Many underscored the difficulty of accessing reliable 'data', 'information' or 'evidence' in FCAS. During a crisis, one contributor explained, "People don't know the importance [of data] at [the] national level and international level, and also the donors are more focused on providing services". A participant working in academia in the United States added that institutional memory loss, a consequence of "continual turnover of government and aid agency personnel" challenges access to information. Further, insecurity limits access to the field. One respondent recounted that travel bans limit access to fragile settings and "once in-country, safety concerns can limit the ways in which researchers can move and interact". Access to research participants is, according to another respondent, challenged by "poor infrastructure and internet access", which makes it "logistically hard to contact people and arrange interviews".
Participants emphasised the need for "more innovative ways of data collection" if insecure areas or populations are to be included in research. The constrained access to information, sites and populations might yield a sampling bias. A respondent from Europe working in funding, contributed: "In FCAS it is difficult to reach the target areas/populations for the research. In more cases, research areas are convenience-selected and based on security and ease-of-access rather than for representativeness of the population/country."
Weak local research capacity
Many respondents highlighted weak local research capacity in FCAS. Research capacity includes both the necessary staffing (numbers, skills and knowledge) and the infrastructure, for instance, ethical review boards, required for conducting high-quality research.
In terms of necessary staffing, many reported limited in-country capacity. An Afghan respondent working in international implementation experienced a "shortage of researchers and data collectors for fielding studies" and "low capacity of the government and non-government institutions to lead and implement research" whilst conducting HSR in FCAS. Consequently, the quality of HSR might be compromised. A respondent from Europe working in international implementation remarked: "Capacity of staff we have found in general to be weaker in conflict affected states. This can affect quality of the research." Other respondents cited that research infrastructure is often disrupted or missing in FCAS. A respondent from the United States commented that ethical review boards are "either non-existent or complicated".
Collaboration challenges
Respondents identified collaboration as a key challenge to conducting HSR in FCAS. The main reason mentioned was that many different actors are commonly involved in health systems strengthening efforts in FCAS, including research. One respondent recounted a complex consensus-building process that included a variety of actors aiming to build "one common agenda and support for research".
Language barriers, both literal and figurative, can make collaboration difficult. In the figurative sense, national researchers voiced a negative perception of the use of the word 'fragile' by international researchers. Further, the use of conceptual language sometimes leads to misunderstandings. A respondent from Sierra Leone who worked on local implementation stated: "Beyond the issues of conducting any type of health research, which were certainly present, the understanding of the very concepts of some of the systematic issues was not entirely present. So [these issues were discussed] with 'buzz words', but not with real understanding of the meaning, for many of our team counterparts."
Lack of trust in the research process
A lack of trust in the research process also stymies collaboration. A survey respondent from Sudan working in academia identified "a lack of trust between the researchers, participants, and the local community" as one of the main challenges of conducting HSR in FCAS. The respondent observed the effects of power differentials within the research process, wherein the researcher exercises power by analysing the data provided by participants. Another respondent noted that significant cultural differences resulted in scepticism towards researchers, whom local residents considered "outsiders".
Further, many respondents stated that political and conflict-related sensitivities made research more difficult in FCAS. One respondent noted that mistrust between communities and state and non-state actors makes qualitative research particularly challenging. Another respondent thought that political and conflict-related sensitivities bias research results and therefore affect research quality. A participant from Europe working in international implementation disclosed: "I interviewed people who had been involved in the health system in South Sudan about health systems strengthening… The main challenges that I encountered were that people still working in South Sudan were often reluctant to speak negatively about the situation as they were worried about repercussions from the government". Another respondent mentioned mistrust relating to the "flow and use of resources" because, he said, in fragile settings "this often is partly on a cash basis, and diversions of funds are not uncommon".
Limited research application
Respondents noted that lessons from the HSR conducted in FCAS were not always applied optimally, often because the findings became rapidly outdated and because institutions do not engage substantially with the research process and its results.
Rapidly outdated findings
Participants highlighted that contexts within FCAS, including their health systems, change rapidly. A respondent from Europe working in international implementation underscored this, saying: "The context in a fragile state is much less predictable and constantly changing, meaning that any gains made in the health system and health systems strengthening can be lost overnight, as in the case of South Sudan. This makes research much harder." He continued by saying that, because the context is constantly changing, it is more difficult "to capture the context at any one particular point in time". Another respondent noted that, because contexts in FCAS change so rapidly, research findings become out-of-date quickly, which reinforces the reality that research must be "tailored to each specific situation".
Lack of engagement with research process and results
Respondents viewed the lack of substantial engagement with the research process and its results as key to poor uptake of HSR. A survey respondent working in Afghanistan explained that national governments were often reluctant "to engage in health research while other immediate issues, such as security and maintenance of power, are at hand". Another factor leading to poor research uptake is lack of "acceptance of results" by policymakers. For example, a respondent from Australia working in academia noted that, in the case of health services utilisation analyses, policymakers often regarded health services clients in FCAS as "unqualified" providers of information upon which to base policy decisions. Respondents cited a lack of clarity regarding "whom to disseminate information for translation to policy and practice to".
Group differences
The authors compared respondents by sex and professional background, which resulted in some notable differences. Male survey respondents more often described challenges related to appropriate support for and engagement with the research process and its results than female respondents. Trust issues were raised four times as often by local implementers and almost three times as often by academics than international implementers. Collaboration challenges were highlighted more often by local (almost four times) and international implementers (almost twice) compared to those working in academia. International implementers predominantly raised the issue of limited research application.
This study shows that those familiar with and directly involved in HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. Using an online survey and documenting a discussion group allowed the authors to consolidate and synthesise the experiences of researchers, funders and implementers from a wide range of countries, including many FCAS.
Contextualising health systems research in FCAS
Results from this study should be contextualised against the background of some broader issues affecting HSR in general and HSR in FCAS specifically. First, HSR is a relatively young field [32] that urgently requires development [33] in order to maximise its contribution to policy and practice. Developing the field is challenging because HSR includes a wide range of complex and interconnected systems and issues (as illustrated by the six WHO building blocks) and is conducted by researchers offering a multitude of diverse disciplinary perspectives [32, 33]. Thus, systematic progression of HSR will take intense effort and coordination across disciplines. Second, the principles for engagement of aid in FCAS increasingly emphasise state building as the central objective [34]. As a result, HSR in FCAS may be critiqued primarily on its contribution to state building rather than on its contribution purely to health outcomes [35]. For this reason, HSR may need to formulate its research more often in relation to fragility, not just being research that happens to be conducted in a fragile state. Finally, the fragile states literature [36] increasingly calls for highly contextualised, flexible approaches for aid in general and for health sector development in particular. This focus demands a highly contextualised and specific evidence base, which may limit research generalisability.
While this study did not specifically collect data on how to address the challenges commonly confronted when conducting HSR in FCAS, some practical recommendations arise from the data.
Need for more sustained support
Health systems strengthening, a lengthy and complex process, should become the primary focus after the transition from humanitarian relief to sustainable development [37]. Evidence suggests that, in addition to improving health outcomes, health systems strengthening may play a significant role in state building by contributing to the reinforcement of government legitimacy [38, 39]. However, because the role of health systems strengthening in influencing health outcomes and state stability in FCAS is insufficiently understood, HSR in FCAS warrants significant and long-term investment.
This study shows that there is currently insufficient institutional support for HSR in FCAS. More funding for HSR in FCAS is required in order to overcome the lack of evidence regarding which health systems strengthening approaches are effective and which are not [40, 41]. Specifically, there is a lack of financial support for and commitment to longitudinal research. Strong longitudinal research is essential to demonstrate the impact of health systems characteristics and strengthening initiatives on health outcomes. More long-term funding would also enable more substantial and nuanced capacity building, and relationship development. Current examples include the ReBUILD Consortium (funded by the United Kingdom's Department for International Development), which is an international research partnership exploring approaches to health systems development in post-conflict settings [42] and RECAP-SL (funded by the European & Developing Countries Clinical Trials Partnership) that aims to build HSR capacity in Sierra Leone. Seed funding grants may prove useful for testing the feasibility of high-risk research in FCAS.
Institutional support extends beyond financial support in enabling researchers to conduct research even in extremely challenging environments. While HSR in FCAS often entails security considerations beyond those normally confronted by research institutions, overly constrictive travel bans or restrictions imposed by institutions, such as universities, limit the development of contextual knowledge, relationships and the research process. We must understand the nature and effects of fragility in order to strengthen health systems within it. Meaningful support for the research process even in light of the pervasive challenges is critical to high-quality HSR in FCAS.
Need for research capacity building
This study shows that investment in research capacity building within FCAS is essential to meet the challenges related to implementation of high-quality research in these complex environments. The study further reinforces the notion that capacity building should not be limited to individual research personnel but should extend to essential research organisations and functions such as universities and ethical review boards [43]. Professional development and retention of skilled people is particularly challenging in fragile situations, where factors that push people out of their environment, such as active conflict, extreme lack of resources and poor leadership, are extremely strong. However, these factors lose intensity in post-conflict situations, thus enabling policies aimed at building and retaining skilled workers to become more relevant [44]. Capacity building undertaken during times of relative stability can enable research to continue during times of instability.
Capacity building is necessary not only because research-related knowledge and skills may be limited as a consequence of disrupted or destroyed education systems, but also because access to FCAS is commonly constrained. In-country authorities or researchers' universities or employers might impose travel bans or restrictions. The security context may be too poor to allow travel. Such constraints may limit research to more stable areas, leading to sampling bias. Capacity building addresses this challenge by enabling researchers based in less stable areas to conduct their research. For example, during the Ebola epidemic, the United Kingdom-based ReBUILD Consortium researchers were unable to travel to Sierra Leone. However, due to capacity-building efforts aimed to empower researchers to work more autonomously since the programme's inception, the United Kingdom-based team was able to provide their support remotely while the Sierra Leone-based team successfully carried out the research [42]. Encouraging any researchers to continue work during conflict requires assessing risks and benefits. Reflection upon the necessity and feasibility of the research is recommended [45]. That said, enabling researchers who live in FCAS to conduct research even in the midst of fragility offers great potential for timely research that truly captures the context in fragile environments.
Need for relationship and trust building
In addition to a need for capacity building within FCAS, this study also shows a need for relationship building among stakeholders, including local communities, government authorities and international researchers. Often overlooked, relationship building is essential to address challenges that arise from a lack of trust in the research process. A growing body of literature suggests that strengthening trust is not just important in research relationships, but is also critical to other societal relationships that are part of health system strengthening after conflict [46]. Our study shows that HSR in FCAS would particularly benefit from increased investment in relationships among local and international research team members as well as between researchers and research participants.
Interestingly, local implementers in this study more commonly raised trust issues than international implementers, donors or academics. Local implementers may more easily recognise this as an issue because management structures within international organisations often empower international staff more than local staff. Local staff may thus feel wary of international stakeholders. Tensions between local and international stakeholders are common in fragile states. In the context of service delivery, tensions between local government and international organisations have been well documented [37, 47]. One could assume that similar tensions exist in the context of research. Research capacity building may redress power imbalances between local and international stakeholders, and improved communication between both parties may increase mutual understanding and trust.
The lack of trust in the relationship between the international researcher and local research participants or communities might exist for similar reasons. However, research brings an additional element that local participants might perceive as a disadvantage, namely that researchers generally hold the power to interpret data collected during the research process. These interpretations may assert considerable influence over policies and programmes that directly affect participants' lives. Research in FCAS requires adapting communication techniques, especially if the subject matter relates to politics or conflict and how these may impact people's lives. Social systems and hierarchies are fluid during conflict and previous studies may not adequately inform research in a new setting or time [48]. This highlights the need for novel approaches to research and the communication of research results [49]. In order to build trust and maximise opportunities to apply research results, it is important to communicate results in a timely fashion not only to policymakers but also to communities. Participatory action research – an approach that involves research participants in the process and therefore equalises the power balance in the research relationship [50] – might be an appropriate solution to address certain research questions.
Need for innovative and flexible approaches
This study reinforces the need for innovative and customised approaches to research design and implementation. Innovation is commonly defined as the use of new ideas or methods. What is novel to one context, however, might not be novel to another. Therefore, the authors suggest that an effective question with which to start is 'What ideas and methods effectively used to facilitate HSR in non-fragile contexts might be transferable to fragile ones?' Zwi et al. [18] suggest that more active participation of refugees and communities in the research process in conflict situations could be promoted.
Researchers and other stakeholders should consider the value of a range of research methods in FCAS. In many cases, descriptive research would be a good starting point. Longitudinal analysis is essential to HSR because it enables analysis of trends and change in personal and organisational behaviour [48]. However, alternative research methods may also yield valuable results. Although longitudinal quantitative methods generally allow statistical testing and prediction modelling, large-scale longitudinal data collection may not be feasible in fluid and insecure environments. Cross-sectional data collection may be more feasible while qualitative methods may be more adaptable and deliver rich, reliable information. Mixed methods research that combines cross-sectional quantitative and qualitative methods may provide well-rounded insight.
The increased availability of information and communication technology, known as eHealth, has shown potential to improve healthcare in developing countries [51], and could be exploited for research purposes. By using an online survey, this study is an example of the opportunity offered by technology. However, the use of technology in research may introduce bias because of the differing levels of access to it [52]. Marked differences in access to technology exist in FCAS, where most people lack access to even the most basic utilities. Future innovations in research should be designed to include communities and vulnerable people within them. Further, they should be designed in such a way that prevailing health inequities are not exacerbated.
Innovative methods of communicating research results should be pursued. Traditional mechanisms, such as academic journals, may not be accessible to decision-makers in FCAS. Research results may have more impact on policy and practice, from the national level to the household level, if communicated quickly, often and through numerous channels. For example, the Afghan Research and Evaluation Unit, an independent research organisation based in Afghanistan, mobilises these principles in communicating research results [53].
The study findings highlight that this need for innovation requires flexibility on the part of research stakeholders, including funders and researchers themselves. This is consistent with previous studies on research in conflict situations [22, 54]. As Barakat and Ellis point out in a discussion paper on research in war circumstances, "Where information is hard to come by, one must do everything possible to encourage chance learning" ([22], p. 153). Giving the example of researchers benefitting from ad-hoc conversations, the authors indicate that such 'chance learning' opportunities are "met with little enthusiasm within the realms of rigid research protocol" ([22], p. 153). Thus, making room for flexibility in terms of funding, design and implementation of HSR allows researchers to respond to changing environments and needs.
This study has several limitations that should be noted when interpreting these findings. First, participation in both the survey and group discussion was based on self-selection. This meant that, although participation required a minimum of experience in HSR in FCAS, this was not corroborated.
Second, there was a lower than expected survey response rate. Survey non-response is a common source of error in survey-based research [55] and this is reflected here. We have documented potential biases that might have arisen from this. A possible reason for non-response is that, at the time of the survey, the Ebola crisis in West Africa was at its peak. It is likely that many potential respondents were actively engaged in Ebola response initiatives, which could have made our target group less responsive to our survey request. Despite a smaller sample size than anticipated (61 instead of 100), data reached saturation as participants across the sample reported similar challenges.
Third, for feasibility reasons, our survey was only available in English and not in any other languages, which could have prevented some candidates from participating.
Fourth, participation in the online survey was reliant on computer and Internet access and familiarity and therefore could have excluded some potential participants (e.g. those from areas in FCAS with limited Internet connection and/or those with limited computer skills).
Fifth, while men and women were relatively equally represented in the online survey, less balance was achieved in relation to work and geographical background – most survey respondents resided in the United Kingdom and were international implementers or academics and thus their views were over-represented in the results.
Finally, the design of this study was guided by its primary aim of developing a consultative research agenda on HSR in FCAS. Identifying challenges in carrying out research in the context of FCAS was a secondary aim. Consequently, participants were primarily targeted based on their familiarity with HSR and not necessarily on their experience with the obstacles of implementing such research. Additionally, this may have limited the depth of the information provided on challenges involved in conducting HSR in FCAS. Future qualitative research on this topic should consider using data collection methods, such as in-depth interviews, that encourage respondents to provide more detailed information.
The potential biases associated with our sampling methods (purposive snowball sampling) and response rate may limit the generalisability of our findings. We did manage to get a good coverage of country experiences (together, participants had experience working in 56 different fragile and/or conflict-affected countries). While these participants self-defined these as fragile and/or conflict affected, the majority are also listed in popular indices [56, 57].
Strong and resilient health systems are critical to population health, yet little is known about how to effectively strengthen health systems in FCAS. The quality of research in FCAS has been previously recognised as poor [15, 21, 25], partly due to its associated challenges [24]. HSR is a complex endeavour even in stable environments with a strong research capacity. Undertaking such research in FCAS is therefore challenging, as confirmed by this study.
This paper provides a better understanding, through wide consultation, of what these challenges are. While recommendations are given on how to overcome some of the challenges identified, additional research on the facilitators of HSR is needed. Further, sharing of best practices will be beneficial. Simply knowing that these challenges are common, perhaps unavoidable, may help stakeholders to remain committed to the research process. More long-term commitment to and investment in health systems in FCAS is crucial to inform the policies and programmes that will increase access to health services and ultimately improve the health outcomes for millions of vulnerable people worldwide.
The TWG-HS-FCAS is a cooperation between the Health & Fragile States Network and the ReBUILD Consortium. As a working group of Health Systems Global, we aim to strengthen HSR in FCAS. http://healthsystemsglobal.org/twg-group/8/Health-Systems-in-Fragile-and-Conflict-Affected-States/.
Third Global Symposium on HSR, organised by Health Systems Global, took place in Cape Town (2014), building on two previous symposia held in Montreux (2010) and Beijing (2012). http://healthsystemsresearch.org/hsr2014/home?qt-programme_at_a_glance=1.
The Health and Fragile States Network, established in 2007 and consisting of practitioners, researchers and funders, aims to contribute to the evidence base on health and fragile states; to influence policy and advocate collectively on a range of issues which impact on health in fragile states; and to support dialogue, debate and networking amongst those working in health and fragile states, and with those who work in other related sectors.
The ReBUILD Consortium conducts research for stronger health systems post conflict. www.rebuildconsortium.com.
The TWG LinkedIn group brings together key actors on health in FCAS and promotes research, policy and advocacy actions to develop and implement responsive and context-specific health systems. https://www.linkedin.com/groups/6611870.
In cooperation with the TWG, BioMed Central's journal Conflict and Health published a series of articles entitled 'Filling the void: Health systems in fragile and conflict affected states'. http://www.conflictandhealth.com/series/Filling_the_void.
This interactive map was developed via 'Google - Map Data' and can be accessed here: https://fusiontables.google.com/DataSource?docid=1nFPsjV6slJjg0v0uPaktlypYzPVc-5sYgDWHLpPD#map:id=3.
FCAS:
fragile and conflict-affected states
HSR:
health systems research
non-governmental organisation
TWG:
Thematic Working Group
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World Bank. Harmonized List of Fragile Situations - FY15 List of Fragile and Conflict Affected Situation Countries. 2015. http://www.worldbank.org/en/topic/fragilityconflictviolence/brief/harmonized-list-of-fragile-situations. Accessed 15 Aug 2016.
We are thankful to all steering committee members for their support throughout the research process. Furthermore, we would like to thank Fernando Maldonado from KIT (Royal Tropical Institute) who helped create the interactive world map, and M T Sheahan for editing this paper.
The Wellcome Trust funded this study. The funding body did not play a role in the design of the study or collection, analysis or interpretation of data, or in writing the manuscript.
The datasets from the current study are available from the corresponding author on reasonable request.
Conceived and designed the study: ES, TM and AW. Collected the data: AW. Analysed the data: AW and KS. Wrote the first draft of the manuscript: ES and AW. Contributed to the writing of the manuscript: AW, KS, TM and ES. All authors read and approved the final manuscript.
The survey introduction provided a written explanation of response confidentiality and voluntary participation. Completion of the survey constituted consent. Participants in the face-to-face group discussion received an information sheet, which included details on the study aim, participation and confidentiality. All participants gave verbal consent at the start of the discussion. This study received ethical approval from the Liverpool School of Tropical Medicine, United Kingdom (14.034).
Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
Aniek Woodward
University of North Carolina, Chapel Hill, NC, United States of America
Kate Sheahan
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
Tim Martineau
KIT (Royal Tropical Institute), Amsterdam, Netherlands
Egbert Sondorp
Correspondence to Tim Martineau.
Online survey. This file shows the survey questions related to challenges from the online survey. (PDF 110 kb)
Woodward, A., Sheahan, K., Martineau, T. et al. Health systems research in fragile and conflict affected states: a qualitative study of associated challenges. Health Res Policy Sys 15, 44 (2017). https://doi.org/10.1186/s12961-017-0204-x
Fragile states
Conflict-affected states


text:
The Border Town
Ling Zifeng
Dai Na
Feng Hanyuani
The Border Town (Chinese name: 边城) is a Chinese movie adapted from the novel of the same name written by Shen Congwen with Dai Na, Feng Hanyuan playing the leading role. It tells a story about a border town which has little connection with outside world in the early Republic of China. This movie has received an Honor Award in the 9th Canada Montreal international film festival and the Golden Rooster Award for Best Director.
Cuicui is raised by her 70-year-old grandfather. 17 years ago, Her mother was pregnant before marriage and she committed suicide after giving birth to Cuicui by drinking cold water in the river. When Cuicui grows up, her grandfather begins to worry about her marriage, because he doesn't want Cuicui to have a miserable life like her mother. There is a rich man in the border town, who has two handsome sons that both fell in love with Cuicui. Cuicui likes the younger son while her grandfather misunderstands her feelings and thinks the older son is more suitable for Cuicui. Unfortunately, the older son dies in an accident and the rich man pins the blame on Cuicui's grandfather. Even though the younger son loves Cuicui, he can't marry her after the death of his dear brother. Finally, he chooses to leave the town. Cuicui's grandfather dies on a cold, rainy night, leaving Cuicui alone in the world. However, grief doesn't break her down. She takes over her grandfather's work, waiting for the younger son to come back.
https://web.archive.org/web/20120426054830/http://www.dy.com.cn/modules/FilmInfo.aspx?FilmID=17748
https://web.archive.org/web/20120425062955/http://book.qq.com/a/20090929/000003.htm
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Mandarin-language films
Chinese film stubs

redpajama_set_name: RedPajamaCommonCrawl


R evenge, Season 3 to date has been consistently a step up from it's all-over-the-map second season, but suddenly it looks like the clear mission to right the wrongs of it becoming a budget version of Batman is starting to slip off the rails.
The entire episode kind of revolves around what Revenge is at its very weakest with – boring supporting characters. Any network drama seems to be littered with these stock waifs and handsome deadweights – actors with uninspired writing and even less inspiring delivery who appear to do nothing but prolong the shelf-life of our favourite shows by keeping the "good stuff" padded out across 22 episodes.
What a faster paced show like Alias largely understood was that at its core, the success of the show was based on the three-to-four central characters….but most importantly the dynamic between two rivals. This is also true of Revenge, except this show seems more than willing to ignore that and give supporting cast members heavy screentime instead.
Not only do we suffer the attempted bitchery from the toddler class in the form of Sara finally striking back (snooze) but we also are once again subjected to the deeply misguided introduction of Niko Takeda as Takeda's daughter, clearly in town with a revenge plot of her own. Niko is played to the hammy 9s by un-engaging Stephanie Jacobsen, and could actually be the worst character the show has ever had.
The problem with Niko is that from the second she appeared onscreen, you could absolutely predict her character trajectory without fail. Of course she was not to be trusted, of course shes Takedas daughter – and of course shes to blame for Emily's blackouts….probably – and shes proven herself weak and flimsy; more interested with shagging Aiden than actually standing up for herself.
Revenge did successfully cull Sara this episode, but it kind of feels like a carousel of supporting actors now, with Niko a few episodes ago joining and now the original Mrs Grayson as one of the cliffhangers at the end. The other cliffhanger was inevitable. Emily is implied to have been sexing Conrad.
The blackout plot has almost immediately worn out its welcome, and the dynamic between Emily and Daniel is an uncomfortable twist for the show rather than one which benefits it. I really do understand that they introduced the plot of sterilizing Emily as a way to reignite her hate for the Grayson's….but one has to wonder how we got so far that such a drastic and ludicrous plot twist has to drive what was the core fundamental of the show forward once more.
At its core, Emily should be subversive in her approach – and that has been stripped away. She's smart and resourceful – so why can't she craft a plan to win the Grayson's back over and slip the dagger in for once and for all?
It feels like after the shooting on the boat, Revenge is suddenly clutching to anything it can grasp to give it new direction. From blackouts to amnesia to new characters – and I'm keen to see in episode 14 if the show can successfully recover or if we are going to have the joy of watching Margaux LeMarchal drive home just how ludicrous and unbuyable it is becoming to see false publications run in television show.
Poor Jack feels like he has less screen-time than any of the female supporting riff-raff combined lately, and whilst Margaux is not quite the deadweight on the show that say, Sara is (given that she is at least played gamely by Karine Vanasse) she isn't exactly Madeline Stowe.
Speaking of which, Madeline Stowe's Victoria is becoming soft. For a woman who is supposed to be the villainous dragon of the Hamptons, she's doing very little in subterfuge lately, and the whole season appears to be softening her by giving her a relationship with Patrick.
Perhaps Emily's real strike in the heart of the beast should be to kill Patrick….another superfluous character, but whos role has been written as such that he could have legitimate strategic value to the show as a whole when he goes.
Five Reasons why Revenge is the best show on tv.
Previous story Welcoming back Getluv.


text:
Iván Aleksándrovich Vsévolozhsky, en ruso Ивáн Алексáндрович Всéволожский (Imperio ruso, 2 de abril de 1835 – San Petersburgo, 10 de noviembre de 1909) fue un diplomático, director de teatro, coreógrafo, libretista y diseñador ruso. Fue el responsable de que existieran ballets mundialmente famosos como La bella durmiente y El cascanueces.

Vida

Primeros años
La familia de Vsévolozhsky procedía de Riúrik, con los príncipes de Smolensk incluidos entre sus ilustres antepasados. Se graduó en la Universidad de San Petersburgo antes de trabajar en la sección asiática del Departamento de Asuntos Internacionales, el consulado ruso en La Haya y como funcionario en San Petersburgo. A pesar de no tener formación en gestión, ni tampoco en teatro, se aficionó al teatro y a la cultura francesa en general durante su estancia en el consulado ruso en París a partir de 1876.

Director de los Teatros Imperiales
Tras la ascensión de Alejandro III, fue nombrado director de los Teatros Imperiales a partir del 3 de septiembre de 1881.Aunque era relativamente desconocido, Vsévolozhsky era una figura vigorosa y "encantadoramente amable" con una "asombrosa perspicacia".  Ostentó el cargo de director de los Teatros Imperiales de Rusia entre 1881 y 1898, primero de los de Moscú y a partir de 1866, de San Petersburgo. Administrador competente, Vsévolozhsky inició ese año dos importantes reformas de los teatros de la capital imperial. Llevó a cabo la reubicación del Ballet Mariinski y la ópera del Teatro Bolshói Kámenny (considerado inseguro en 1886) al Teatro Mariinski. Por otra parte, suprimió el puesto de primer compositor del Ballet Imperial, cargo que habían tenido músicos como Léon Minkus y Cesare Pugni.

Encargó a Chaikovski la composición de los ballets La bella durmiente (1890) y El cascanueces (1892), para los que él mismo escribió los libretos en colaboración con Marius Petipa. En 1888 encargó al maestro de ballet  imperial Petipa la coreografía de un ballet completo sobre el cuento "La bella durmiente" para un estreno en el Teatro Mariinsky. Logró que escribiera la partitura el más famoso compositor ruso, un tal Chaikovski. Vsevolojskoy escribió él mismo el libreto; en su carrera, había sido tanto dramaturgo como ensayista y también era un talentoso artista capaz de diseñar trajes para el teatro. Gracias a su visión, se dice que el ballet La bella durmiente (1890) tenía la escenografía y el vestuario más caros y elaborados jamás vistos. Fue un laborioso diseñador de trajes, que preparó al menos 1087 dibujos para 25 o más producciones, incluidas las representaciones originales de La bella durmiente en 1890 y El cascanueces en 1892.

Como gran admirador de la música de Chaikovski, contribuyó a llevar a escena tres de las últimas óperas de este compositor, a saber, La encantadora (1886), La dama de picas (1889, con libreto de Pushkin por el hermano del compositor, Modesto Chaikovski), y Iolanta (1892, también con libreto de Modesto). Iolanta (a veces escrita como Iolanthe) fue encargada expresamente por Vsevolozhsky como la primera parte de una velada de gala en dos actos que concluiría con un ballet llamado El cascanueces. Este ballet en dos actos pretendía mostrar la coreografía del maestro de ballet imperial Petipa, pero finalmente fue creado por el ayudante del maestro de ballet Lev Ivanov, debido al deterioro de la salud de Petipa. El estreno de Iolanta y El cascanueces, el 6 de diciembre de 1892, fue un leve éxito y llevó al célebre compositor a creer que gozaría de cierta popularidad durante "al menos un par de años".

Entre sus grandes cambios administrativos como director se encuentra la formación de un comité para determinar el repertorio, los aumentos salariales para artistas y trabajadores (algunos de los cuales se multiplicaron por siete) y el aumento de los honorarios de los autores al 10% (desde el 2%). Sin embargo, algunas medidas no tuvieron éxito, como su prohibición de la distribución gratuita de entradas, el aumento del tamaño de la orquesta y la ampliación de los derechos de producción de carteles teatrales. Lo más cuestionado fue su coste; las reformas aumentaron el gasto 10 veces más que su predecesor, el barón Kister, y los intentos de subir el precio de las entradas fueron "universalmente condenados".

Relaciones artísticas
Las preferencias artísticas de Vsévolozhsky eran francesas, aunque fue su trato personal, refinado pero sin pretensiones, lo que atrajo a Chaikovski a trabajar con él. Fue uno de los partidarios más vehementes de Chaikovski. Esta relación, sin embargo, funcionaba en ambos sentidos; la demanda de nueva música eclipsaba la oferta y fue esta presión permanente la que llevó a Chaikovski a volver al ballet tras la tibia recepción de El lago de los cisnes, así como la generosa facilitación de Vsevolozhsky para que reanudara sus esfuerzos. El diario del compositor sugiere que existía una estrecha relación entre él y el director; relata que acudió a la casa del primero para una reunión creativa urgente que incluía a Marius Petipa y a Alexandre Petrovich Frolov.

Vsévolozhsky defendió igualmente a Marius Petipa, con quien mantuvo una fructífera relación que culminó con producciones de L'Ordre du roi, Les ruses d'amour y La bella durmiente que se hicieron eco de la época dorada del ballet francés. Sin embargo, su principal lealtad siguió siendo la causa por la que había sido nombrado, es decir, la defensa del ballet ruso. Sus críticos, como Skalkovsky, lamentaron la falta de bailarines extranjeros, y sólo en casos excepcionales vaciló en su compromiso con el arte ruso, como atestigua Wiley. Esto también reflejaba los deseos de la familia real rusa; el zar había abolido la ópera imperial italiana en favor de la rusa antes de su nombramiento. También se esperaba que Vsévolozhsky influyera positivamente en la literatura rusa, las costumbres sociales y la conciencia nacional. Se desconocen sus opiniones sobre el monopolio estatal de las producciones teatrales, aunque los críticos contemporáneos apreciaron su papel en el mantenimiento de espectáculos de alto nivel y calidad (por ejemplo, en contraposición a la Ópera de París).

Últimos años
En 1899 Vsévolozhsky se convirtió en director del Museo del Hermitage hasta su muerte en 1909. Se casó con Ekaterina Dmitrievna Volkonsky, nieta de Príncipe mariscal de campo P.M. Volkonsky (1776-1852) que, bajo el mando del zar Alejandro I, había participado en la batalla de Austerlitz contra Napoleón.

Galería

Referencias

Enlaces externos

Ballet de Rusia
Fallecidos en San Petersburgo

redpajama_set_name: RedPajamaWikipedia


text:
Denny McCarthy
FPPG: 72.1 | FanDuel Salary: $10,600
FanDuel Fantasy Points Per Game More DFS
Made Cut
Bogeys
Double Bogeys
Fortinet Championship (-6.14) (64.04%) (2.40%) (12.00%) (19.88%) (36.96%) (0.37) (14.09) (36.89) (6.85) (0.86) $10,600 (69.2172) (6.53)
Sanderson Farms Championship (-3.10) (67.80%) (2.72%) (11.80%) (20.28%) (38.84%) (0.3) (12.89) (38.02) (8.16) (1.05) $10,500 (61.3716) (5.84)
Shriners Children's Open (-2.60) (66.04%) (2.16%) (9.80%) (18.24%) (36.24%) (0.24) (12.44) (37.99) (8.04) (1.06) N/A (58.7964) N/A
THE CJ CUP in South Carolina (1.20) (90.36%) (1.24%) (8.20%) (16.84%) (41.76%) (0.22) (12.40) (43.54) (10.92) (1.46) $8,300 (55.8686) (6.73)
Butterfield Bermuda Championship (-4.21) (62.40%) (1.40%) (8.08%) (14.32%) (30.24%) (0.36) (13.14) (36.39) (7.62) (0.95) $12,000 (62.2712) (5.19)
Cadence Bank Houston Open (2.89) (59.44%) (1.04%) (5.32%) (11.04%) (26.04%) (0.19) (9.51) (36.45) (9.91) (1.34) $10,800 (41.2462) (3.82)
The RSM Classic (-2.64) (50.76%) (0.48%) (4.16%) (7.60%) (19.28%) (0.26) (11.49) (34.23) (7.33) (0.96) $10,400 (52.7698) (5.07)
Sony Open in Hawaii (0.21) (52.80%) (0.64%) (4.04%) (9.00%) (20.60%) (0.22) (10.12) (35.12) (8.47) (1.08) $9,600 (45.4844) (4.74)
The American Express (-3.77) (55.32%) (0.36%) (3.08%) (7.28%) (19.64%) (0.35) (12.46) (34.84) (7.28) (0.98) $9,000 (57.715) (6.41)
Fortinet Championship -7 1 25 0 12 55 5 0 $10,600 67.5872 6.38
Sanderson Farms Championship -7 1 39 0 17 45 10 0 $10,500 76.6 7.3
Shriners Children's Open -2 0 90 0 9 21 5 1 N/A 35.3 N/A
THE CJ CUP in South Carolina -3 1 37 0 12 53 5 2 $8,300 54.9 6.61
Butterfield Bermuda Championship -16 1 6 1 22 41 8 0 $12,000 113.4 9.45
Cadence Bank Houston Open 4 1 54 1 10 50 8 3 $10,800 52.4 4.85
The RSM Classic -7 1 46 1 12 52 7 0 $10,400 70.2 6.75
Sony Open in Hawaii -9 1 28 0 17 48 7 0 $9,600 80.9022 8.43
The American Express -14 1 45 0 22 42 8 0 $9,000 97.7 10.86
PGA News
Daily Fantasy Golf: The Heat Check Podcast for the Farmers Insurance Open
Covering the Spread: NBA Betting for Tuesday 1/24/23 and PGA Farmers Insurance Open
PGA Betting Guide for the Farmers Insurance Open
Mike Rodden —
Farmers Insurance Open: Best Bets, Daily Fantasy Golf Picks, Course Key Stats, and Win Simulations
PGA Betting Guide for the American Express
Daily Fantasy Golf: The Heat Check Podcast for The American Express


text:
A Made in France selection by Bruit
It's the turn of the band Bruit ≤ to give us their selection of Made in France favourites!
Bruit ≤ have emerged from the ashes of several other pop groups, and is a project born of the desire of its members to turn their back on the majors and to return to a spirit of uninhibited creation. Together they aim to create a progressive music that subverts the pop genre and expands stylistic frontiers. Bruit ≤ signed to Elusive Sound in July 2018, releasing their debut EP, Monolith, in the autumn of the same year.
After a 20-date tour of France and Belgium, the band concentrated on writing their debut album The machine is burning and now everyone knows it could happen again. It had a digital release in April 2021, followed by a physical release in December 2021 in their new label Pelagic record
Après une sortie digitale en avril 2021 et une apparition remarquée à la version online du Dunk festival, le groupe signe en décembre 2021 avec le label Pelagic Records.
A Made In France Selection By BRUIT ≤
Listen to a selection of made in France tracks, carefully handpicked by BRUIT ≤.
Video Zinée | What the France Live Shot At the Francofolies festival this year, What the France met up with Zinée. Get to know the artist with her "Live Shot", where she talks a... Video Yndi | What the France Live Shot At this year's Francofolies festival What The France interviewed Yndifor her Live Shot video. The singer reveals all about her live experience&#...


"Freedom and Grace" original painted mural by Tofu Cat.
"Freedom and Grace" is a 2009 original painted mural on canvas created by Tofu Cat. The mural is painted in acrylic on canvas and the outer measurements are 25 1/4H x 31 1/2W.
Imagine having your own "window" in your home or office that looks out onto the beautiful pastoral setting of Farm Sanctuary, NY complete with some of the inquisitive animal personalities looking back at you. The winning bidder will also receive the personal story of each animal included in the mural. Freedom the cow, Grace the sheep, Ami the goat and Rudy the pig signify the freedom and grace experienced by all animals cared for at Farm Sanctuary.
In condition as donated. Cannot be returned or exchanged. The mural will be rolled up and shipped in amailing tube. Instructions included on how the mural can be either adhered to a wall or framed.


Women are on the rise in Spanish politics. Spain's newly-formed government consists of eleven women and six men. The newly-elected socialist Prime Minister Pedro Sanchez has put women in some of the biggest positions in his cabinet, including head of defence, economy, education and finance. Spain now has the highest proportion of women in top government positions than anywhere else in Europe. In a televised statement, Mr Sanchez said his new government consisted of people who wanted to move Spain forward. He said: "All are highly qualified and bring a vocation for public service and reflect the best of Spain. [They are]...open to the world but anchored in the European Union."
Mr Sanchez seems an unlikely leader. His Socialist party holds just 84 of the 350 seats in Spain's parliament. He took office on Friday, replacing the unpopular conservative leader Mariano Rajoy. Ex-prime minister Rajoy was the focus of a corruption scandal and had become unpopular because of his austerity measures. Sanchez promised to bring change to Spain. However, he has to work quickly to turn Spain's economy around. He has promised to call elections in less than two years, which may not be enough time to amend the outgoing government's budget for 2018. One of his biggest challenges will be rebuilding relations with the northeastern region of Catalonia.
1. WOMEN IN POWER: Students walk around the class and talk to other students about women in power. Change partners often and share your findings.
3. 50:50: Students A strongly believe all government should consist of an equal split between men and women; Students B strongly believe this is silly. Change partners again and talk about your conversations.
4. CABINET: What would you do if you help these posts in your country's government? Complete this table. Change partners often and share what you wrote with your partner(s).
5. RISE: Spend one minute writing down all of the different words you associate with the word "rise". Share your words with your partner(s) and talk about them. Together, put the words into different categories.
6. MINISTERS: Rank these with your partner. Put the most important at the top. Change partners often and share your rankings.
1. consists a. Chosen to hold public office or some other position by people voting.
2. elected b. A part, share, or number considered in comparative relation to a whole.
3. cabinet c. Is made up of.
4. proportion d. A strong feeling of suitability for a particular career or job.
5. statement e. A definite or clear expression of something in speech or writing.
6. vocation f. Heavily attached to something.
7. anchored g. A committee of the senior ministers responsible for controlling government policy.
8. parliament h. An estimate of income and expenditure for a set period of time.
9. corruption i. A plan or course of action taken to achieve a particular purpose.
10. austerity j. Make minor changes in (a text) in order to make it fairer, more accurate, or more up-to-date.
11. measures k. The highest committee in a country. It makes all the decisions for running the country.
12. amend l. Dishonest or fraudulent conduct by those in power, usually involving taking money illegally.
13. outgoing m. Leaving an office or position, especially after an election defeat or completed term of office.
14. budget n. Difficult economic conditions created by government measures to reduce a budget deficit, especially by reducing public expenditure.
Women are on the (1) ____________ in Spanish politics. Spain's newly-formed government (2) ____________ of eleven women and six men. The newly-elected socialist Prime Minister Pedro Sanchez has put women in some of the biggest positions in his (3) ____________, including head of defence, economy, education and finance. Spain now has the highest (4) ____________ of women in top government positions than anywhere else in Europe. In a (5) ____________ statement, Mr Sanchez said his new government consisted of people who wanted to move Spain forward. He said: "All are highly (6) ____________ and bring a vocation for public service and (7) ____________ the best of Spain. [They are]...open to the world but (8) ____________ in the European Union."
Mr Sanchez seems an (9) ____________ leader. His Socialist party holds just 84 of the 350 seats in Spain's parliament. He took (10) ____________ on Friday, replacing the unpopular conservative leader Mariano Rajoy. Ex-prime minister Rajoy was the (11) ____________ of a corruption scandal and had become unpopular because of his (12) ____________ measures. Sanchez promised to bring change to Spain. However, he has to work quickly to turn Spain's economy around. He has (13) ____________ to call elections in less than two years, which may not be enough time to (14) ____________ the outgoing government's budget for 2018. One of his biggest (15) ____________ will be rebuilding relations with the northeastern (16) ____________ of Catalonia.
Women are (1) ___________________ in Spanish politics. Spain's newly-formed government consists of eleven women and six men. The newly-elected socialist Prime Minister Pedro Sanchez has put women (2) ___________________ the biggest positions in his cabinet, including head of defence, economy, education and finance. Spain now has the (3) ___________________ women in top government positions than anywhere else in Europe. In a televised statement, Mr Sanchez said his new government (4) ___________________ who wanted to move Spain forward. He said: "All are highly qualified and (5) ___________________ for public service and reflect the best of Spain. [They are]...open to the world but (6) ___________________ European Union."
Mr Sanchez (7) ___________________ leader. His Socialist party holds just 84 of the 350 seats in Spain's parliament. He (8) ___________________ Friday, replacing the unpopular conservative leader Mariano Rajoy. Ex-prime minister Rajoy was (9) ___________________ a corruption scandal and had become unpopular because (10) ___________________ measures. Sanchez promised to bring change to Spain. However, he has to work quickly to turn Spain's economy around. He has promised to call elections in less than two years, which may not (11) ___________________ to amend the outgoing government's budget for 2018. One of his biggest challenges will be rebuilding relations with the (12) ___________________ Catalonia.
How many parliamentary seats does Pedro Sanchez's party hold?
What kind of scandal is Spain's ex-prime minister involved in?
1) How many women were appointed to top government posts in Spain?
2) Which European country has the highest ratio of women in top posts?
3) What medium did Pedro Sanchez use to make his statement?
4) What did Pedro Sanchez say his government brings to public service?
5) What did Pedro Sanchez say his government was anchored in?
6) How many parliamentary seats does Pedro Sanchez's party hold?
7) What kind of scandal is Spain's ex-prime minister involved in?
8) What did Pedro Sanchez promise to bring to Spain?
9) When did Pedro Sanchez say he would call the next elections?
10) What does Pedro Sanchez have to build relations with?
You think defence is the most important area of government. Tell the others three reasons why. Tell them why their areas aren't as important. Also, tell the others which is the least important of these (and why): economy, health or education.
You think economy is the most important area of government. Tell the others three reasons why. Tell them why their areas aren't as important. Also, tell the others which is the least important of these (and why): defence, health or education.
You think health is the most important area of government. Tell the others three reasons why. Tell them why their areas aren't as important. Also, tell the others which is the least important of these (and why): economy, defence or education.
You think education is the most important area of government. Tell the others three reasons why. Tell them why their areas aren't as important. Also, tell the others which is the least important of these (and why): economy, health or defence.
What images are in your mind when you hear the word 'politics'?
What do you think of the politics in your country?
Are there many women politicians in your country?
Should all governments be a healthy mix of men and women?
How do men and women lead differently?
Who is the greatest male leader of all time?
How would you like to move your country forward?
Would you be good working for the public service?
What kind of global view do you have?
What do you think of when you hear the word 'government'?
Would you be a good politician?
What do you think of austerity measures?
Who is the greatest female leader ever?
What advice do you have for Spain's prime minister?
What are the biggest challenges your government has?
What questions would you like to ask Spain's prime minister?
Women are on the (1) ____ in Spanish politics. Spain's newly-formed government consists of eleven women and six men. The newly-elected socialist Prime Minister Pedro Sanchez has put women in some of the biggest positions in his (2) ____, including head of defence, economy, education and finance. Spain now has the highest (3) ____ of women in top government positions than anywhere (4) ____ in Europe. In a televised statement, Mr Sanchez said his new government consisted of people who wanted to move Spain forward. He said: "All are highly qualified and bring a (5) ____ for public service and (6) ____ the best of Spain. [They are]...open to the world but anchored in the European Union."
Mr Sanchez seems an (7) ____ leader. His Socialist party holds just 84 of the 350 seats in Spain's parliament. He (8) ____ office on Friday, replacing the unpopular conservative leader Mariano Rajoy. Ex-prime minister Rajoy was the focus of a corruption scandal and had become unpopular because of his (9) ____ measures. Sanchez promised to bring change to Spain. However, he has to work quickly to turn Spain's economy around. He has promised to (10) ____ elections in less than two years, which may not be enough time to (11) ____ the outgoing government's budget for 2018. One of his biggest challenges will be rebuilding relations with the northeastern region (12) ____ Catalonia.
(...) be rebuilding relations with the northeastern region of Catalonia.
(...) the best of Spain. [They are]...open to the world but anchored in the European Union."
quickly Spain's Work to economy turn around .
Women are on the raise / rise in Spanish politics. Spain's newly-formed government consists / contrasts of eleven women and six men. The newly-elected socialist Prime Minister Pedro Sanchez has put women in / on some of the biggest positions in his cabinet, including head off / of defence, economy, education and finance. Spain now has the highest proposition / proportion of women in top government positions than anywhere or / else in Europe. In / On a televised statement, Mr Sanchez said his new government consisted of people who wanted to move Spain forwarding / forward. He said: "All are highly qualified and bring a vocation / vacation for public service and reflect the best of Spain. [They are]...open to the world but anchored / rankled in the European Union."
Mr Sanchez seems an unlikely / likely leader. His Socialist party holds just 84 of / off the 350 seats in Spain's parliament. He gave / took office on Friday, replacing the unpopular conservative leader Mariano Rajoy. Ex-prime minister Rajoy was the fracas / focus of a corruption scandal and had become unpopular because of his austerity measured / measures. Sanchez promised to bring change / charge to Spain. However, he has to work quickly to turn / revolve Spain's economy around. He has promised to call / voice elections in less than two years, which may not be enough time to attend / amend the outgoing government's budget for 2018. One of his biggest challenges will been / be rebuilding relations with the northeastern region of Catalonia.
W_m_n _r_ _n t h_ r_s_ _n S p_n_s h p_l_t_c s . S p__ n ' s n_w l y - f_r m_d g_v_r n m_n t c_n s_s t s _f _l_v_n w_m_n _n d s_x m_n . T h_ n_w l y -_l_c t_d s_c__ l_s t P r_m_ M_n_s t_r P_d r_ S_n c h_z h_s p_t w_m_n _n s_m_ _f t h_ b_g g_s t p_s_t__ n s _n h_s c_b_n_t , _n c l_d_n g h__ d _f d_f_n c_, _c_n_m y , _d_c_t__ n _n d f_n_n c_. S p__ n n_w h_s t h_ h_g h_s t p r_p_r t__ n _f w_m_n _n t_p g_v_r n m_n t p_s_t__ n s t h_n _n y w h_r_ _l s_ _n E_r_p_. I n _ t_l_v_s_d s t_t_m_n t , M r S_n c h_z s__ d h_s n_w g_v_r n m_n t c_n s_s t_d _f p__ p l_ w h_ w_n t_d t_ m_v_ S p__ n f_r w_r d . H_ s__ d : " A l l _r_ h_g h l y q__ l_f__ d _n d b r_n g _ v_c_t__ n f_r p_b l_c s_r v_c_ _n d r_f l_c t t h_ b_s t _f S p__ n . [ T h_y _r_] . . ._p_n t_ t h_ w_r l d b_t _n c h_r_d _n t h_ E_r_p__ n U n__ n . "
M r S_n c h_z s__ m s _n _n l_k_l y l__ d_r . H_s S_c__ l_s t p_r t y h_l d s j_s t 8 4 _f t h_ 3 5 0 s__ t s _n S p__ n ' s p_r l__ m_n t . H_ t__ k _f f_c_ _n F r_d_y , r_p l_c_n g t h_ _n p_p_l_r c_n s_r v_t_v_ l__ d_r M_r__ n_ R_j_y . E x - p r_m_ m_n_s t_r R_j_y w_s t h_ f_c_s _f _ c_r r_p t__ n s c_n d_l _n d h_d b_c_m_ _n p_p_l_r b_c__ s_ _f h_s __ s t_r_t y m__ s_r_s . S_n c h_z p r_m_s_d t_ b r_n g c h_n g_ t_ S p__ n . H_w_v_r , h_ h_s t_ w_r k q__ c k l y t_ t_r n S p__ n ' s _c_n_m y _r__ n d . H_ h_s p r_m_s_d t_ c_l l _l_c t__ n s _n l_s s t h_n t w_ y__ r s , w h_c h m_y n_t b_ _n__ g h t_m_ t_ _m_n d t h_ __ t g__ n g g_v_r n m_n t ' s b_d g_t f_r 2 0 1 8 . O n_ _f h_s b_g g_s t c h_l l_n g_s w_l l b_ r_b__ l d_n g r_l_t__ n s w_t h t h_ n_r t h__ s t_r n r_g__ n _f C_t_l_n__ .
mr sanchez seems an unlikely leader his socialist party holds just 84 of the 350 seats in spains parliament he took office on friday replacing the unpopular conservative leader mariano rajoy exprime minister rajoy was the focus of a corruption scandal and had become unpopular because of his austerity measures sanchez promised to bring change to spain however he has to work quickly to turn spains economy around he has promised to call elections in less than two years which may not be enough time to amend the outgoing governments budget for 2018 one of his biggest challenges will be rebuilding relations with the northeastern region of catalonia.
Write about women in power for 10 minutes. Comment on your partner's paper.
Women in power make life better for other women. Discuss.
3. WOMEN IN POWER: Make a poster about women in power. Show your work to your classmates in the next lesson. Did you all have similar things?
4. 50:50 Write a magazine article about all governments and company boards being half men, half women. Include imaginary interviews with people who are for and against this.
6. LETTER: Write a letter to an expert on women in power. Ask him/her three questions about this. Give him/her three of your opinions on why women are better leaders. Read your letter to your partner(s) in your next lesson. Your partner(s) will answer your questions.


Visit Lorain County the way it should be seen. Take the family on an RV trip this year with Neff Brothers RV Rentals & Service. Neff Brothers rents trailers and motor homes.
They have a "rental" to fit your style and budget. With their "flex" pricing, last minute getaways can be a great deal any time of the year.
If you are traveling in the area and need your personal RV serviced , they have certified technicians that can help!
Neff's has moved! Visit their new facility…it's bigger and better with the same great service and products. Their parts store has expanded too!


Challenging discrimination is not easy, but Lucy Stone is never one to take the easy road. The first woman from Massachusetts to earn a college degree, Lucy defies every obstacle and is an ardent supporter of human rights. Always fierce, her belief that women and men be equal is evident in both her political and personal endeavors. Her message inspired thousands of women to join the suffrage movement; Susan B. Anthony credits Lucy's impassioned speeches for her involvement.
As a scholar, Lucy intensely studied Greek and Hebrew and vehemently insists that the Holy Bible has been mistranslated to oppress and objectify women. There is no way Lucy will settle for second best, even in her marriage! She created a marriage protest to be read in place of her wedding vows and refused to take her husband's surname, leading to the moniker of a "Lucy Stoner" to describe a woman who does just that!
In this fiery presentation, Lucy describes the tension of Antebellum Boston. Her discussion touches on the gender caste system and also encompasses the fierce abolitionist movement. Women were evolving from successful abolitionists to struggling suffragists! Their fight was ferocious, so come along for the ride! Suitable for all ages. Running Time: Approx. 60 minutes.


2Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey Kanra GY, Özen H, Kara A. Infection and anorexia. Turk J Pediatr 2006; 48: 279-287.
Whereas anorexia is a common behavioral response to infectious diseases, the reasons for and mechanisms behind this observation are still unknown. When it is considered on an evolutionary basis, the organism must have net benefits from anorexia.