Healthcare research, planning, and delivery with minimal community engagement can result in financial wastage, failure to meet objectives, and frustration in the communities that programmes are des...

In response to climate change at different spatial scales, adaptation has become one of the focal points of current research and policy developments. In the context of coastal Cambodia, there is little research on local level adaptation to climate change. Using ordinal logistic and logistic regression analyses, this study examines the relationship between perceived self-efficacy and anticipatory and reactive adaptation to climate change among 1823 households in coastal communities in Cambodia. Findings indicate that individuals who reported higher categories of self-efficacy were more likely to report both anticipatory (OR = 1.74, p < 0.001) and reactive adaptation (OR = 3.61, p < 0.001) measures. Similary, tndividuals who had higher education had higher odds of reporting anticipatory adaptation (OR = 1.71, p < 0.001) and reactive adaptation (OR = 1.63, p < 0.05) when compared with those without formal education. Participants who have been living in their current residence for six years or more were more likely to report anticipatory adaptation (OR = 1.09, p < 0.05) and reactive adapation (OR = 1.22, p < 0.001) compared with those who had lived there for a shorter duration of time. Region of residence was positively associated with both anticipatory and reactive adaptation. In this context, it is important to note that individuals in the most agriculture-dependent and climate sensitive province reported the least anticipatory and reactive adaptation measures. Policy makers should target empowerment of the most vulnerable population to facilitate better adaptation behavior, and mainstreaming of knowledge on climate change adaptation through both formal and informal education at the community level.

Summary: Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated.

Introduction: Strengthening health systems in conflict-affected settings has become increasingly professionalised. However, evaluation remains challenging and often insufficiently documented in the literature. Many, particularly small-scale health system evaluations, are conducted by government bodies or non-governmental organisations (NGO) with limited capacity to publish their experiences. It is essential to identify the existing literature and main findings as a baseline for future efforts to evaluate the capacity and resilience of conflict-affected health systems. We thus aimed to synthesise the scope of methodological approaches and methods used in the peer-reviewed literature on health system evaluation in conflict-affected settings. Methods: We conducted a scoping review using Arksey and O’Malley’s method and synthesised findings using the WHO health system ‘building blocks’ framework. Results: We included 58 eligible sources of 2,355 screened, which included examination of health systems or components in 26 conflict-affected countries, primarily South Sudan and Afghanistan (7 sources each), Democratic Republic of the Congo (6), and Palestine (5). Most sources (86%) were led by foreign academic institutes and international donors and focused on health services delivery (78%), with qualitative designs predominating (53%). Theoretical or conceptual grounding was extremely limited and study designs were not generally complex, as many sources (43%) were NGO project evaluations for international donors and relied on simple and lower-cost methods. Sources were also limited in terms of geography (e.g., limited coverage of the Americas region), by component (e.g., preferences for specific components such as service delivery), gendered (e.g., limited participation of women), and colonised (e.g., limited authorship and research leadership from affected countries). Conclusion: The evaluation literature in conflict-affected settings remains limited in scope and content, favouring simplified study designs and methods, and including those components and projects implemented or funded internationally. Many identified challenges and limitations (e.g., limited innovation/contextualisation, poor engagement with local actors, gender and language biases) could be mitigated with more rigorous and systematic evaluation approaches.