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The Gabgachhia village is located in the coastal region of Bangladesh's Khulna district. It is one of the seven villages selected for the CCAFS midline household survey. The village was also selected for the village midline study (VMS). The community has witnessed multiple changes in resources, institutional setting, infrastructure and organizational activities, especially surrounding natural resources management as well as on food security issues, farming systems development and management. These changes might be attributable to a combination of factors among which population increase, different resource utilization and mobilization patterns, adoption of new varieties and as responses to climate change impacts. Although forests have been depleted, there are some initiatives to support roadside plantation and social forestry. The low productivity in farmlands due to rising salinity, flooding and the cultivation of inappropriate crop varieties has improved since the baseline with soil salinity problems lessening with time. The farmlands are usually rain-fed but initiatives for better irrigation with sluice-gate operations improved the situation and farmers reported adopting improved varieties. The drinking water situation is reported to have improved. However, in order to meet higher demands for water, the community has to collect significant amounts of water from around the area and from more distant communities. Initiatives to harvest rainwater and conserve water for the winter season are reported to have gained in popularity. Infrastructure is also reported to have improved but to not be enough to withstand population and environment pressures. Subsistence farming of rice, 'gher'-farming, as well as some fruit and vegetables production, aquaculture and limited poultry and livestock production are reported to be the main sources of food in Gabgachhia village. Improvement in available income generating opportunities, farming practices, agricultural production and in access to drinking water, as well as the setting up of a mother care centre, better education facilities for future generations, and finally, fully functioning canals and a greener environment were core aspects of the village's vision for the future. Many organizations are working in and around the village and beyond, representing the government, NGOs, private sector and international entities as well as community organizations. The organizations identified in the village focused on religion, education, health, income generation, loans, local governance, agriculture, fisheries, water and disasters response. The local government is central in providing and coordinating development activities and services. The community's organizations strongly support mosques and schools among others. Several organizations were reported to target food security related issues and improved nutrition, access to finance, capacity building for income generation, and water management. Some organizations were reported to shift their focus and provide assistance when a disaster or crisis occurred by providing food, clothing, drinking water, medicine and financial support to construct houses. The community also identified a handful of organizations addressing natural resource management, with a focus on water management infrastructure, biodiversity conservation, aquaculture and agroforestry training, and the provision of tree saplings. The analysis of linkages within and between organizations pointed out high levels of vertical linkages within organizations but limited horizontal linkages due to a lack of coordination between organizations. The organizations were noted to focus on their own efforts and to not engage with other institutions beyond the local government. Organizational support is provided on a regular basis and is especially active in times of needs. Yet, the lack of coordination and limited resources remain important constraints. The participants in the village midline study also reported on their means of access to information and provided details on their sources of information for weather, agriculture, livestock/poultry, aquaculture and disasters and other crisis related issues. Both formal and informal sources were noted to be popular in the community with the majority of information being shared between neighbours or acquired through the radio and television and through the government and local administration.

An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.

An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.