Integration was achieved by designing a practical surveillance model and adequately involving multilevel stakeholders to play their individual roles (e.g. promoting bug searches, sending bugs to health centres, monitoring surveillance tasks, and providing materials) in such a way to continue improving the performance.
The health centres demonstrated capacity to manage the community-based surveillance system in terms of performance, knowledge and awareness of schoolchildren, vector report-response, and seroprevalence, once the tasks were simplified to be performed by trained non-specialists, and collaborated actively by multilevel stakeholders.
This study also reveals that the greatest barriers to the adoption and sustainability of new technologies include sharing technical and economic information broadly and providing opportunities for legitimate multilevel stakeholder participation in decision-making processes.
Key evaluation features, best practices in implementation science, and current practices in risk-minimization program evaluation are summarized in Table 3.> Due to the multilevel, multi-stakeholder nature of risk-minimization programs, no single methodology is sufficient for conducting a robust evaluation of program implementation and impact.
We address the following major points considered to be of importance for EBM implementation: (1) multilevel cooperation, (2) stakeholders' involvement, (3) sharing of information, (4) bridging science and policy, and (5) consensus-based decision making.
8 Programmatically, these interventions require a multilevel approach, involving a range of stakeholders (particularly adolescents themselves) and will need to be adapted to local contexts.
The output included multilevel (individual, household and community) data that engaged stakeholders at each level.
In a longitudinal retrospective quantitative analysis of publicly available data we searched for factors associated with initiation, duration and outcome of CED decisions; with focused qualitative interviews of key stakeholders we searched for soft factors within the multilevel decision process.
In future work, researchers will engage stakeholders to identify culturally-relevant strategies that address the multilevel factors that perpetuate smoking in order to promote cessation and abstinence in AHWs.
Table 9 shows the actions recommended by focal points from the Rwandan stakeholder institutions, which demonstrated a desire for a multilevel, multisectoral response to violence in the health sector, as well as awareness of the need to address gender discrimination and violence together.
When a company engages in multilevel interactions, the tension and conflict in the level that involves more stakeholders could be mitigated by developing relationships at the level where fewer stakeholders are involved, or by further isolating the interaction between the individual company and the state officials.
