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Background: Globally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa. Methods: An explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model. Results: The practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge. Conclusions: Advocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support. [ABSTRACT FROM AUTHOR]

In this paper, I recount my experiences with western media theory. Working on my PhD thesis marked my turn to decolonial theory. I used the creolisation strategy of putting critical western Marxist theories in conversation with African, black and Latin American decolonial theories. I worked on my PhD thesis under conditions informed by the Rhodes Must Fall (RMF), the Fees Must Fall (FMF) and other broader protests in South Africa whose connecting thread was the demand for the decolonisation of both the academy and public life. It is my conviction that, although work has already begun, there is still a lot of work to be done in decolonising the disciplines of journalism, media and cultural studies. [ABSTRACT FROM AUTHOR]

Early in South Africa's HIV/AIDS crisis, entertainment education emerged as a powerful vehicle for communicating health and social messaging to combat the epidemic. Applied theatre now accounts for the majority of arts-based HIV interventions in sub-Saharan Africa, and continues a history of theatre for social change in South Africa in particular. While much has been written about the dramaturgical and communication theories that support such interventions, the role of music, a formidable tool in the applied theatre intervention arsenal, has received considerably less attention within applied arts intervention scholarship. This paper draws from Durkheim's collective effervescence to propose a theoretical approach to music within the creation and maintenance of effervescent assemblies that is being employed by HIV/AIDS interventions to encourage participation in HIV testing. The theoretical model of musical effervescence is situated within ethnographic fieldwork conducted while accompanying an applied HIV/AIDS theatre company on a national tour of South Africa. [ABSTRACT FROM AUTHOR]

Within the framework of the current drive to transform psychology in South Africa, this paper highlights "other" axes of identity that are arguably largely overlooked within the field. The conversation exposes the discipline of psychology – specifically within the South African context – and its many unexamined assumptions concerning "expected" identities of psychologists – specifically, those along heterosexual and able-bodied lines. By engaging in an autoethnographic conversation, the two authors, both "other", practising psychologists – one queer, one disabled – share and reflect on some of their experiences of feeling othered in their chosen profession. Drawing on parts of queer theory, critical disability literature, as well as the theoretical framework of biopolitical power, we start to make sense of our experiences of difference, deviance, and defiance. How the field of psychology marginalises "other" psychologists, and the impacts on those who bear the oppressions, is exposed; and a conversation is begun in which the discipline's assumptions around compulsory forms of identity – straight, not disabled, among others – are disrupted in productive ways. [ABSTRACT FROM AUTHOR]

A conceptual confusion of theory exists in South African Open Distance and e-Learning (ODeL) research in which the concept is used with borderline, related, contrary, invented, or illegitimate concepts such as a model, approach, construct, hypothesis, theoretical framework, or conceptual framework. As a result, some researchers choose not to apply theory, apply a narrow definition, or risk their manuscripts being rejected when theory is inadequately applied. This article seeks to expand the understanding of the concept theory in South African ODeL research. In particular, the purpose of the paper is to clarify the meaning and reduce ambiguities surrounding theory, as well as promote consistency in using the concept in South African ODeL research. Subsequently, the article develops a conceptual framework through a comprehensive literature review, and through the application of the eight steps for a concept analysis. This framework consists of six conceptual components related to the application of theory in order to meet the expected outcome of a particular ODeL research project. Four of the components that are deemed more important include defining attributes, identifying model cases, antecedents, consequences and empirical referents. The conceptual framework serves as a thinking tool for an integrated and deepened understanding of the concept theory and for enhancing the appropriate use of theories in South African ODeL research. [ABSTRACT FROM AUTHOR]

The Practice of Everyday Life (de Certeau M (1984) The Practice of Everyday Life. Berkeley, CA: University of California Press) has become a canonical text in urban studies, with de Certeau's idea of tactics having been widely deployed to understand and theorise the everyday. Tactics of resistance were contrasted with the strategies of the powerful, but the ways in which these strategies are operationalised were left ambiguous by de Certeau and have remained undertheorised since. We address this lacuna through an examination of the planning profession in South Africa as a lieu propre – a strategic territory with considerable power to shape urban environments. Based on a large interview data set examining practitioner attitudes toward the state of the profession in South Africa, this paper argues that the strategies of the powerful are themselves subject to negotiation. We trace connections with de Certeau's earlier work to critique the idea that strategies are univocal. We do this by examining how the interests of different powerful actors can come into conflict, using the planning profession as an exemplar of how opposing strategies must be mediated in order to secure changes in society. [ABSTRACT FROM AUTHOR]

INTRODUCTION The health consequences of smoking are serious and have been frequently detailed. A reduction in tobacco-related mortality hinges upon the ability to reduce tobacco usage. There is overwhelming evidence that higher cigarette prices reduce the demand for cigarettes, but little is known about the combined effect of price and non-price policies. This paper seeks to extend the analysis of price elasticities by estimating the combined effect of changes in price and non-price legislations in South Africa. METHODS Annual time-series data from 1961 to 2016 are used, with a policy index constructed to capture the instances of non-price tobacco legislation. We estimate the combined impact of changes in tobacco control policy on cigarette consumption using a vector error correction model (VECM) and a two-stage least squares (2SLS) model. RESULTS The estimated long-run own-price elasticities lie between -0.55 and -0.72, while the income elasticities lie between 0.39 and 0.49. The coefficients of the changing tobacco control policies and the changing market structure show that they contribute to a modest reduction in cigarette consumption. The short-run deviations from the steady state are presented using the error correction term (ECT). CONCLUSIONS Cigarette demand is responsive to cigarette prices and non-pricing policies but failure to control for non-pricing policies overstates the price effect. This suggests that both cigarette prices and non-pricing legislation are effective in reducing cigarette consumption. [ABSTRACT FROM AUTHOR]

This paper reports part of the findings from a 2014 audit of shelters for street children conducted in four provinces of South Africa. The paper focuses on the assessment of the types, structure and implementation of the programmes, as well as on the adequacy of resources necessary for implementing the programmes. The overall picture that emerged from the assessment was that all shelters draw on a comprehensive and enabling legislative and policy framework to offer some elements of developmental, therapeutic and recreational programmes at the early intervention level. Overall, however, the implementation of the programmes does not effectively take into consideration the varied and interconnected factors that, within and across multiple social systems, impel children to the streets. It was thus apparent that the programmes do not adequately address the risks and opportunities of street children in South Africa, specifically within the eco‐developmental framework. Recommendations are offered for social work policy and practice to further enhance the quality and impact of programmes offered in the shelters. [ABSTRACT FROM AUTHOR]

This paper focuses on the aesthetics of the fine art, photographic representation of the dead body in Pieter Hugo’s photographic series,The Bereaved, produced in 2005. The series consists of four close-up colour photographs of the faces of men who died of AIDS-related illnesses and were photographed in their caskets, in an informal morgue in Khayelitsha, Cape Town, South Africa. Katarzyna Majak’s theory of socialisation as an attempt to lessen the scandal of the corpse through representation is central as an analytical tool throughout this paper. Majak argues that for the viewer the corpse is a scandal, because it discomfortingly presents the transformation of a body from subject to object. For Majak, socialisation is essentially the taming of the dead body, achieved by re-presenting the corpse as an individual. This paper expands on Majak’s valuable theory by arguing that socialisation is a continuum between emphasising the subject-ness of the deceased individual, rather than the object-ness of the corpse as matter. Importantly, this continuum reveals varying degrees of socialisation within Hugo’s series, and other fine art examples discussed. Socialisation offers an alternative reading of the series concerned with the absence of the subject created by death and representation. [ABSTRACT FROM AUTHOR]

This paper analyses data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) on the prevalence of reported fear of crime at home and on the street among older people in China, Ghana, India, Mexico, Russia and South Africa. SAGE provides nationally representative data for 35,125 people aged 50 and over. These reveal large national variations in reported crime fear: for example, 65 per cent of older South Africans felt unsafe on the street, compared to only 9 per cent of older Ghanaians. The paper examines factors potentially associated with crime fear, including age, socio-economic status and frailty, and relates these to different theoretical models of crime fear. Female sex and frailty are associated with higher rates of crime fear across the study countries. Other associations are less consistent, e.g. urban residence is associated with higher levels of fear in some countries and lower levels in others. The paper considers the potential effects of crime fear on mobility beyond the home, health status and quality of life. A strong association is found for mobility, but effects on health and quality of life are harder to interpret as the direction of causality can be two-way. Overall, the paper demonstrates the potential impact of crime fear on older people's wellbeing and highlights a need for further, more contextualised research. [ABSTRACT FROM PUBLISHER]

Purpose:This paper proposes practice guidelines to evaluate community-based rehabilitation (CBR) programs. Method:These were developed through a rigorous three-phase research process including a literature review on good practices in CBR program evaluation, a field study during which a South Africa CBR program was evaluated, and a Delphi study to generate consensus among a highly credible panel of CBR experts from a wide range of backgrounds and geographical areas. Results:The 10 guidelines developed are summarized into a practice model highlighting key features of sound CBR program evaluation. They strongly indicate that sound CBR evaluations are those that give a voice and as much control as possible to the most affected groups, embrace the challenge of diversity, and foster use of evaluation processes and findings through a rigorous, collaborative and empowering approach. Conclusions:The practice guidelines should facilitate CBR evaluation decisions in respect to facilitating an evaluation process, using frameworks and designing methods.Implications for rehabilitationTen practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:• being as participatory and empowering as possible;• ensuring that all, including the most affected, have a real opportunity to share their thoughts;• highly considering mixed methods and participatory tools;• adapting to fit evaluation context, local culture and language(s);• defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate. [ABSTRACT FROM AUTHOR]

Sustainability assessment is a recent framing of impact assessment that places emphasis on delivering positive net sustainability gains now and into the future. It can be directed to any type of decision-making, can take many forms and is fundamentally pluralistic. Drawing mainly on theoretical papers along with the few case study examples published to date (from England, Western Australia, South Africa and Canada), this paper outlines what might be considered state-of-the-art sustainability assessment. Such processes must: (i) address sustainability imperatives with positive progress towards sustainability; (ii) establish a workable concept of sustainability in the context of individual decisions/assessments; (iii) adopt formal mechanisms for managing unavoidable trade-offs in an open, participative and accountable manner; (iv) embrace the pluralistic inevitabilities of sustainability assessment; and (v) engender learning throughout. We postulate that sustainability assessment may be at the beginning of a phase of expansion not seen since environmental impact assessment was adopted worldwide. [ABSTRACT FROM AUTHOR]

This paper takes the form of an account of the emergence of the field of psychoanalytically informed parent-infant/child psychotherapy in South Africa. It traces the origins and the development of the South African field by locating local practice within the international field. The influential links between international approaches and local practice and services are described. The historical account is based on a review of published parent-infant/child literature, including South African authored texts. Interviews with key local stakeholders and practitioners supplement the literature review. This paper endeavours to locate parent-infant/child psychotherapy more clearly on the map of mental health work in South Africa, and in so doing to promote the work as both a relevant and valuable intervention. [ABSTRACT FROM PUBLISHER]

The United Nations estimates that 79% of teenage girls trafficked globally every year are forced into involuntary prostitution. About 247 000 South African children work in exploitative conditions; about 40 000 South African female teenagers work as prostitutes. This paper investigates lifestyles and routine activities of teenagers at risk of being trafficked for involuntary prostitution. The key concepts involuntary prostitution, intergenerational sex and exploitative conditions are defined in relation to the lifestyles and routine activities of South African female teenagers. Human trafficking for involuntary prostitution is described, based on a literature review. Lifestyle exposure and routine activities theories help to explain the potential victimisation of these teenagers in human trafficking for involuntary prostitution. Actual lifestyle and routine activities of South African teenagers and risky behaviours (substance abuse, intergenerational sex and child prostitution) are discussed as factors that make teens vulnerable to such trafficking. This paper recommends that human trafficking prevention efforts (awareness programmes and information campaigns) be directed at places frequented by human traffickers and teenagers in the absence of a capable guardian to reduce victimisation, as traffickers analyse the lifestyles and routine activities of their targets. South Africa should also interrogate entrenched practices such as intergenerational sex. [ABSTRACT FROM AUTHOR]

The modern theory of investment identifies the importance of uncertainty to investment. A number of empirical studies have tested the theory on South African time series, employing political instability measures as proxies for uncertainty. This paper verifies that political instability measures are required in the formulation of the investment function for South Africa. It also establishes that there are distinct institutional factors that influence the uncertainty variable such as property rights and crime levels. We find that rising income and property rights lower political instability, and that rising crime levels are positively related to political instability. The inference is that political instability in South Africa may not represent uncertainty directly, since it is systematically related to a set of determinants. Instead, uncertainty would have to be understood as being related to a broader institutional nexus that in concert may generate uncertainty for investors. The paper highlights the significance of getting institutions right to ensure that uncertainty is kept to a minimum by providing a predictable long-term environment. Stability at a systemic level appears crucial if investment rates are to rise in South Africa and this paper demonstrates that stability in turn is driven by a sound institutional environment that has multiple dimensions. [ABSTRACT FROM AUTHOR]

In order to achieve optimal benefits of antiretroviral therapy (ART), caregivers of children receiving ART are required to attend routine clinic visits monthly and administer medication to the child as prescribed. Yet, the level of adherence to these behaviours varies considerably in many settings. As a way to achieve optimal adherence in rural KwaZulu-Natal, caregivers are required to attend routine counselling sessions at HIV treatment clinics that are centred on imparting information, motivation, and behavioural skills related to medication administration. According to the information-motivation-behavioural skills model, information related to adherence, motivation, and behavioural skills are necessary and fundamental determinants of adherence to ART. The purpose of the study was to observe and document the content of adherence counselling sessions that caregivers attending rural clinics in KwaZulu Natal receive. We observed 25 adherence counselling sessions, which lasted on average 8.1 minutes. Counselling typically consisted of counsellors recording patient attendance, reporting CD4 count and viral load results to caregivers, emphasising dose times, and asking caregivers to name their medications and dosage amounts. Patients were seldom asked to demonstrate how they measure the medication. They were also not probed for problems regarding treatment, even when an unsuppressed VL was reported to a caregiver. This paper calls attention to the sub-optimal level of counselling provided to patients on ART and the urgent need to standardise and improve the training, support, and debriefing provided to counsellors. [ABSTRACT FROM PUBLISHER]

Background: Setting priorities is important in health research given the limited resources available for research. Various guidelines exist to assist in the priority setting process; however, priority setting still faces significant challenges such as the clear ranking of identified priorities. The World Health Organization (WHO) proposed a Disability Adjusted Life Year (DALY)-based model to rank priorities by research area (basic, health systems and biomedical) by dividing the DALYs into 'unavertable with existing interventions', 'avertable with improved efficiency' and 'avertable with existing but non-cost-effective interventions', respectively. However, the model has conceptual flaws and no clear methodology for its construction. Therefore, the aim of this paper was to amend the model to address these flaws, and develop a clear methodology by using tuberculosis in South Africa as a worked example.Methods: An amended model was constructed to represent total DALYs as the product of DALYs per person and absolute burden of disease. These figures were calculated for all countries from WHO datasets. The lowest figures achieved by any country were assumed to represent 'unavertable with existing interventions' if extrapolated to South Africa. The ratio of 'cost per patient treated' (adjusted for purchasing power and outcome weighted) between South Africa and the best country was used to calculate the 'avertable with improved efficiency section'. Finally, 'avertable with existing but non-cost-effective interventions' was calculated using Disease Control Priorities Project efficacy data, and the ratio between the best intervention and South Africa's current intervention, irrespective of cost.Results: The amended model shows that South Africa has a tuberculosis burden of 1,009,837.3 DALYs; 0.009% of DALYs are unavertable with existing interventions and 96.3% of DALYs could be averted with improvements in efficiency. Of the remaining DALYs, a further 56.9% could be averted with existing but non-cost-effective interventions.Conclusions: The amended model was successfully constructed using limited data sources. The generalizability of the data used is the main limitation of the model. More complex formulas are required to deal with such potential confounding variables; however, the results act as starting point for development of a more robust model. [ABSTRACT FROM AUTHOR]

Leadership support has been identified as an essential component of successful workplace health promotion (WHP) programs. However, there is little research in this area and even less theoretical conceptualization on ways in which leadership support for WHP is related to improved employee wellbeing. In this paper, we developed and tested a model of leadership support for WHP and employee wellbeing outcomes using employer and employee data gathered from 71 South African organizations. A theoretical model based on social exchange theory was developed. It was hypothesized that perceptions of company commitment to health promotion mediates the relationship between leadership support, the provision of WHP facilities and employee wellbeing. A hierarchical structural equation modeling technique was used to test the model. We determined that leaders' support for WHP was important insofar as they also provided health promotion facilities to their employees. No direct relationship was found between leadership support alone and employee wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: Based on the bioecological model by Bronfenbrenner, this paper will provide a broad perspective on factors that need to be taken into account in order to facilitate communication and participation in preliterate children making use of electronic Augmentative and Alternative Communication (AAC) systems accessed through eye gaze. Method: Two case studies of children who have been provided with the technology described are presented. The case studies were analysed using the four nested systems of the ecology as a framework to describe not only the environment, but also the processes and interactions between the persons and their context. Results: Risk and opportunity factors are evident at all levels of the ecology. Conclusions: While a good fit between the person and the technology is an essential starting point, additional factors pertaining to the partner, the immediate environment as well as meso-, exo- and macrosystemic issues (such as societal attitudes and funding sources) have a significant influence on benefits derived. In resource-limited environments, the lack of support at more distal levels of the ecology (meso-, exo- and marosystemic levels) seems to be a factor that differentiates these environments from more resourced ones. [ABSTRACT FROM AUTHOR]

The use of religion and spirituality in psychotherapy has been a contentious issue for decades. This paper explores and describes whether psychologists would use religion and spirituality in psychotherapy as well as enablers and barriers in this regard. A qualitative exploratory descriptive method was followed using purposive sampling to obtain a sample of clinical and counselling psychologists. The focus group strategy was used to collect the data, and Tesch's model of content analysis was used to analyse the qualitative findings. Most participants expressed a willingness to discuss religion and spirituality with their clients. Participants also highlighted specific enablers and barriers to incorporating religion and spirituality in psychotherapy. This article has the potential to influence professional training in psychology and psychotherapy. [ABSTRACT FROM AUTHOR]

With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma. [ABSTRACT FROM PUBLISHER]

This paper reports on a two-pronged qualitative research study that used leaders' life stories and the case research method to understand the leadership of change in 14 South African organizations. We describe how leaders led the changes required to balance the imperatives emanating from South Africa's socio-political changes and return the country to the international business arena, as well as the challenges created by years of inequality and neglect of the socio-economic development of the majority of its population. We found that the leaders' life stories played a significant role in how they perceived and responded to the change situation. Four themes summarizing the actions of the leaders - namely, their efforts to embrace change, to provide hope, to connect change to African values and culture, and to champion diversity - are described. The results of the study suggest that leaders' life stories can be an important source of information about how they perceive, interpret, and respond to change. [ABSTRACT FROM AUTHOR]

This paper deconstructs the conflict leading up to and shortly following the democratic transition in South Africa. A simple instrument is used in order to identify the main components of the conflict. The information gathered by the instrument is then analyzed using three different theories: regime transition theory, norm socialization using the Spiral Model of Socialization developed by Risse and Sikkink (Kollman, 2008, p. 400), and finally a short comparison to John Duckitt and Thobi Mphuthing's attitudinal study of pre- and post- electoral South Africa will be provided (Mphuthing & Duckitt, 1998). The explanations given by the three approaches are then compared and contrasted in order to gain a more holistic understanding of the South African transition. [ABSTRACT FROM AUTHOR]

How do we account for the close personal bonds and deeply caring relationships forged by educators with learners in many adult educational encounters? The literature is relatively silent on the emotional and relational basis to adult educator work. This is a serious silence, given the stressful nature of adult education in developing contexts such as South Africa and the relative vulnerability of such educators. This article addresses this gap by exploring a range of theoretical and conceptual frameworks which may help navigate the relational and affective landscape of adult educator work as care work. Here the frameworks of African perspectives on learning, feminist perspectives on learning, expanded conceptions of transformative learning and Freire’s pedagogy of love are considered. The second part of the article shares some findings on adult educators’ emotional and relational bonds with learners from a study of the Human Rights Democracy and Development project and discusses these practices in light of the theories discussed. A summative table of the various frameworks together with a discussion of their implications for adult education practice, research and policy forms part of this latter section. [ABSTRACT FROM AUTHOR]

Background: The general practitioner contracting initiative (GPCI) is a health systems strengthening initiative piloted in the first phase of national health insurance (NHI) implementation in South Africa as it progresses towards universal health coverage (UHC). GPCI aimed to address the shortage of doctors in the public sector by contracting-in private sector general practitioners (GPs) to render services in public primary health care clinics. This paper explores the early inception and emergence of the GPCI. It describes three models of contracting-in that emerged and interrogates key factors influencing their evolution. Methods: This qualitative multi-case study draws on three cases. Data collection comprised document review, key informant interviews and focus group discussions with national, provincial and district managers as well as GPs (n = 68). Walt and Gilson's health policy analysis triangle and Liu's conceptual framework on contracting-out were used to explore the policy content, process, actors and contractual arrangements involved. Results: Three models of contracting-in emerged, based on the type of purchaser: a centralized-purchaser model, a decentralized-purchaser model and a contracted-purchaser model. These models are funded from a single central source but have varying levels of involvement of national, provincial and district managers. Funds are channelled from purchaser to provider in slightly different ways. Contract formality differed slightly by model and was found to be influenced by context and type of purchaser. Conceptualization of the GPCI was primarily a nationally-driven process in a context of high-level political will to address inequity through NHI implementation. Emergence of the models was influenced by three main factors, flexibility in the piloting process, managerial capacity and financial management capacity. Conclusion: The GPCI models were iterations of the centralized-purchaser model. Emergence of the other models was strongly influenced by purchaser capacity to manage contracts, payments and recruitment processes. Findings from the decentralized-purchaser model show importance of local context, provincial capacity and experience on influencing evolution of the models. Whilst contract characteristics need to be well defined, allowing for adaptability to the local context and capacity is critical. Purchaser capacity, existing systems and institutional knowledge and experience in contracting and financial management should be considered before adopting a decentralized implementation approach. [ABSTRACT FROM AUTHOR]