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The impact of the Belt and Road Initiative (BRI) to global development will be unprecedented and significant, and developmental impact evaluation is therefore central to understanding BRI projects and making informed decisions. Compared with evaluations of individual projects and programs, evaluation of large and mega infrastructure projects under the BRI is particularly challenging and complex in integrating stakeholder objectives, accounting for social benefit and costs, and tracking long-term project impact. In this paper, we summarize the key drawbacks of existing BRI evaluation frameworks, propose a systematic evaluation framework elicitation method based on the inputs from BRI subject matter experts and verified through stakeholder participation, and apply an interim evaluation framework in understanding the Mombasa-Nairobi Standard Gauge Railway project in Kenya, as a proof of concept of a comprehensive evaluation framework. In doing so, we seek to provide a tool for BRI decision makers and stakeholders to assess these projects holistically at planning, construction and operation stages.

The 2019 novel coronavirus disease emerged in China in late 2019–early 2020 and spread rapidly. China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist. Public mental health interventions should be formally integrated into public health preparedness and emergency response plans.

This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1-4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination.The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1-4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings.

The Belt and Road Initiative (BRI) provides a critical platform to fight COVID-19 through the strengthened collaboration, improved supply chain, elevated digital infrastructure, and more sustainable financing. BRI that integrate health with economic development may offer a new paradigm for building a resilient health system to address disease epidemics.

Background Illegally manufactured potent synthetic opioids (IMPSO) like fentanyl have contributed to rises in overdose deaths in parts of North America and Europe. While many of these substances are produced in Asia, there is little evidence they have entered markets there. We consider the susceptibility to IMPSO’s encroachment in markets in the Asia-Pacific region. Methods Our analysis focuses on Australia, China, India, and Myanmar. Using a mixed-methods approach comprising interviews, literature review, and secondary data analyses, we examine factors facilitating or impeding incursion of IMPSO. Finally, we illustrate the potential for IMPSO fatalities in Australia. Results Australia reports some signs of three facilitating factors to IMPSO’s emergence: 1) existing illicit opioid markets, 2) disruption of opioid supply, and 3) user preferences. The other three countries report only existing illicit opioid markets. While diverted pharmaceutical opioids are a noted problem in Australia and India, heroin is the dominant opioid in all four countries. There are divergent trends in heroin use, with use declining in China, increasing in India, and stable in Australia and Myanmar. If IMPSO diffused in Australia as in North America from 2014 to 2018, and our assumptions generally hold, deaths from IMPSO could range from 1500–5700 over a five-year period. Conclusions This analysis and illustrative calculations serve as an early indication for policymakers. With the exception of Australia, many countries in the region fail to properly record overdose deaths or monitor changes in local drug markets. Early assessment and monitoring can give officials a better understanding of these changing threats.

Today, the world is experiencing a pandemic caused by a novel coronavirus. COVID-19 is the third disease from a coronavirus to cause a global outbreak, after severe acute respiratory syndrome (SARS...

There is an urgent need for an assessment of public health interventions to address coronavirus disease 2019 (COVID-19) and determine when to relax them. This document describes the COVID-19 Decision Support Tool, which is designed to fill that need.

Document submitted on June 23, 2020, as an addendum to testimony before the U.S.-China Economic and Security Review Commission on May 7, 2020.

Document submitted March 5, 2020, as an addendum to testimony before the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation on February 5, 2020.

Testimony presented before the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation on February 5, 2020.

We aim to compare the values and challenges of peer outreach workers (POWs) with a history of drug use with non-POWs (NPOWs) in a needle and syringe exchange program (NSEP) in Yunnan, China. Data were abstracted from two independent surveys of 98 outreach workers and 33 program managers in 2014. POWs were more likely than NPOWs to conduct active outreach and to report ease in exchanging needles. Commonly cited concerns from POWs were low wages and frustration with client follow-up. Managers expressed the most concern on high turnover rates and low education levels. POWs seem to be more effective than NPOWs in conducting outreach, though POWs face unique challenges. We call for a recognition of the challenges and needs for more sensitive support for POWs.

Document submitted on August 19, 2019, as an addendum to testimony before the U.S.-China Economic and Security Review Commission on July 31, 2019.

Testimony presented before the U.S.-China Economic and Security Review Commission on July 31, 2019.

ObjectivesThe aim of this study was to examine the pathway and associations among acculturation (ie, language, social interaction and lifestyle), psychological adjustment and mental health of internal migrant adolescents in China.DesignCross-sectional questionnaire study.SettingSix private migrant junior high schools located in Tianhe and Baiyun districts in Guangzhou were chosen as the study sites.ParticipantsA total of 1122 migrant adolescents aged 11–17 years old completed the study.Main outcome measuresMental health was measured by using the Social Anxiety Scale for Children (SASC) and major depression disorder (MDD) in a Brief Child and Family Phone Interview. Acculturation and psychological adjustment were measured by a self-designed and verified questionnaire. Multiple regression models and structural equation models were performed to analyse the association among acculturation, psychological adjustment and mental health while controlling for participant demographic characteristics.ResultsThe average MDD score for boys was 8.78 (SD=2.17) and for girls was 8.56 (SD=2.22), while the average SASC score for boys was 14.67 (SD=3.72) and for girls was 13.41 (SD=4.01). Psychological adjustment had a direct positive effect on MDD (pConclusionsThe association between acculturation and the mental health of internal migrant adolescents was complex and could be mediated by psychological adjustment. Interventions such as promoting local language and social interaction are needed to enhance psychological adjustment and further improve the mental health of migrant adolescents.

Background As an emerging donor in health related development across the world, particularly towards Africa, the People’s Republic of China (PRC) has been increasing its influence within the field of global public health over the past few decades. Yet between the period of 2000 and 2013, little is known about the scope, scale and priority of China’s grant-making programs. Methods Based on data sourced from the China Aid Database (version-1.2), descriptive analyses were applied to analyze the features of 531 health related projects that were undertaken between 2000 and 2013. Spearmen correlation was also performed to assess the relationship between China’s export and aid to recipient countries. Results The total value of China’s grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD, with 531 projects undertaken. During the five year period between 2004 and 2008, China had a contribution of 1.54 billion USD, which increased to 3.8 billion USD during the five year period between 2009 and 2013 – an 146.26% increase. In terms of specific diseases, China is most concerned with building an African public health system through donations targeted towards general health (313 projects), combating Malaria (115 projects) and maternal, neonatal and child health (MNCH), (12 projects). When it comes to recipient countries, if counted in total value, Zimbabwe received the most financial assistance from China, totaling 1.08 billion USD and 19 projects, while Angola and Tanzania received more projects - 30 and 29 projects respectively. In terms of the channeling of aid funding, most projects were targeted towards infrastructure, equipment and medicine (304 projects in total), followed by medical teams (189 projects). Moreover, there is a statistically significant relationship between aid to Africa and Chinese exports to Africa. Conclusion During the past decade, Chinese aid projects played an important role in the African public health system through providing funding for infrastructure, equipment and medicine, training health professionals, as well as disease treatment. However, very limited attention was paid towards disease prevention, health promotion and awareness initiatives, and health education. Furthermore, serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.

Background Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association. Method Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker’s self-efficacy with infrequent condom use change as client and venue characteristics were added to the models. Results We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95–3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12–3.91 and 2.54 95% CI = 1.24–5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32–11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use. Conclusion Our findings suggest sex worker’s self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.

Objective. This research was conducted to assess the correlates of alcohol consumption and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Shandong province, China.Methods. A cross-sectional survey provided demographics, sexual behaviors, illicit drug use, alcohol consumptions, and service utilization.Results. Of 1,230 participants, 82.8% were single, 85.7% aged 3 times per week in the past six months. The average total score of stigmatizing and discriminatory attitude was 37.4 ± 4.4. More frequent episodes of alcohol use were independently associated with higher levels of HIV/AIDS-related stigma and discrimination, unprotected anal sex, bisexual identity, multiple male sex partners, drug use, and lower levels of education. Expressing higher levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with alcohol use, unprotected male anal sex, bisexuals, more male sex partners, commercial sex with men, and non-receipt of peer education in the past year.Conclusion. HIV/AIDS-related stigmatizing and discriminatory attitudes are common and associated with alcohol use and unprotected sex among MSM. The finding highlights the needs to develop programs that would reduce HIV/AIDS-related stigmatizing and discriminatory attitudes and strengthen alcohol use prevention and risk reduction initiatives among MSM.