The impact of official development aid on maternal and reproductive health outcomes: a systematic review.

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The Impact of Official Development Aid on Maternal and Reproductive Health Outcomes: A Systematic Review Emma Michelle Taylor1*, Rachel Hayman2, Fay Crawford3, Patricia Jeffery4, James Smith1 1 Centre of African Studies, University of Edinburgh, Edinburgh, United Kingdom, 2 International NGO Training and Research Centre, Oxford, United Kingdom, 3 Centre for Population Health Services, University of Edinburgh, Edinburgh, United Kingdom, 4 Sociology, University of Edinburgh, Edinburgh, United Kingdom Abstract Background: Progress toward meeting Millennium Development Goal 5, which aims to improve maternal and reproductive health outcomes, is behind schedule. This is despite ever increasing volumes of official development aid targeting the goal, calling into question the distribution and efficacy of aid. The 2005 Paris Declaration on Aid Effectiveness represented a global commitment to reform aid practices in order to improve development outcomes, encouraging a shift toward collaborative aid arrangements which support the national plans of aid recipient countries (and discouraging unaligned donor projects). Methods and Findings: We conducted a systematic review to summarise the evidence of the impact on MDG 5 outcomes of official development aid delivered in line with Paris aid effectiveness principles and to compare this with the impact of aid in general on MDG 5 outcomes. Searches of electronic databases identified 30 studies reporting aid-funded interventions designed to improve maternal and reproductive health outcomes. Aid interventions appear to be associated with small improvements in the MDG indicators, although it is not clear whether changes are happening because of the manner in which aid is delivered. The data do not allow for a meaningful comparison between Paris style and general aid. The review identified discernible gaps in the evidence base on aid interventions targeting MDG 5, notably on indicators MDG 5.4 (adolescent birth rate) and 5.6 (unmet need for family planning). Discussion: This review presents the first systematic review of the impact of official development aid delivered according to the Paris principles and aid delivered outside this framework on MDG 5 outcomes. Its findings point to major gaps in the evidence base and should be used to inform new approaches and methodologies aimed at measuring the impact of official development aid. Citation: Taylor EM, Hayman R, Crawford F, Jeffery P, Smith J (2013) The Impact of Official Development Aid on Maternal and Reproductive Health Outcomes: A Systematic Review. PLoS ONE 8(2): e56271. doi:10.1371/journal.pone.0056271 Editor: Philippa Middleton, The University of Adelaide, Australia Received July 26, 2012; Accepted January 8, 2013; Published February 22, 2013 Copyright: ß 2013 Taylor et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was funded by the United Kingdom’s Department for International Development ( (grant number PO 40031130). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: Introduction In 2000, United Nations member states signed up to the Millennium Development Goals (MDGs), a set of eight international development targets intended to catalyse development and reduce global poverty. To date progress towards these goals has been uneven. Of particular concern is Millennium Development Goal 5 (MDG 5), which aims to improve maternal and reproductive health by reducing the maternal mortality ratio (MMR) by 75% and creating universal access to reproductive healthcare by 2015. Current estimates suggest that this initiative is behind schedule. Only 23 countries out of a surveyed 181 are likely to meet the MMR target on time despite increasing volumes of official development aid being provided by donors [1,2]. There is concern, therefore, that not all the aid targeting MDG 5 is reaching the countries in the greatest need or being delivered in an effective manner [2,3]. The adoption of the MDGs came at the end of a decade in which the purpose and usefulness of official development aid had come under increased scrutiny. The changing geopolitical climate of the 1990s, coupled with the poor results of decades of work and billions of dollars aimed at improving social and economic conditions in poor countries, led to a questioning of the usefulness and effectiveness of overseas development aid. In the 2000s, a series of global high-level fora, involving international institutions, governments of developed and developing countries, and aid agencies, was held to debate the provision of aid and its management. These resulted in global commitments aimed at improving the effectiveness of aid. Central to these was the Paris Declaration on Aid Effectiveness which was signed in 2005 by over 100 agencies and governments [4]. The adoption of the Paris Declaration in 2005 represented the commitment of the international community to improve aid management and delivery. The Paris Declaration was a political statement, which set out guiding principles that signatories were expected to adopt in their delivery of and use of aid. The underlying theory was that aid delivered according to five principles (the Paris Principles) - ownership, alignment, harmonisation, managing for results and mutual accountability – would contribute to improved development outcomes by virtue of all partners working together to achieve the objectives set out in national development strategies (figure 1). This approach aimed to PLOS ONE | 1 February 2013 | Volume 8 | Issue 2 | e56271 Impact of Aid on Maternal and Reproductive Health Figure 1. Paris Principles. doi:10.1371/journal.pone.0056271.g001 address the problems arising from donors funding multiple, unaligned projects outside the control, and sometimes even the knowledge, of the authorities of the country (figures 2 and 3). Various methods, indicators and tools were subsequently devised to track progress in the implementation of the Paris Principles, including country-level (donor and beneficiary) surveys and evaluation frameworks; and large-scale multi-country evaluations [5,6]. The question of whether the revised aid agenda epitomised by the Paris Declaration – and its sister document the Accra Agenda for Action which was adopted in 2008 and reconfirmed the Paris Principles – is having an impact on MDG 5 is pertinent as the 2015 deadline approaches [7]. To date the majority of studies tracking the effect of the Paris Declaration have focused on shifts in the practice and management of aid – i.e. the processes around aid delivery - rather than on evaluating outcomes. This systematic review was commissioned by the UK’s Department for International Development (DFID) in 2010, ahead of the 4th High Level Forum on Aid Effectiveness which was held in Busan in 2011. It was one of a number of reviews commissioned as a pilot exercise to enhance the evidence base on the impact of development interventions and inform international development policy. This particular systematic review emerged from a desire to take the research base one step further than those studies exploring the implementation of the Paris Declaration, by focusing on studies which present robust evidence of the impact of interventions delivered in the context of the Paris Principles in bringing about changes in maternal and reproductive health outcomes. At the request of the commissioning body, the review also took a comparative approach - assessing the impact of aid not delivered according to the Paris Principles on maternal and reproductive health. The objectives of the review are 1) to summarise the evidence of the impact on MDG 5 outcomes of delivering official development aid in line with Paris and Accra aid effectiveness principles and 2) to compare this with the impact of aid in general on MDG 5 outcomes. The review question was set by DFID. Figure 2. Flow diagram depicting the theorised impact of aid delivered under the Paris principles. doi:10.1371/journal.pone.0056271.g002 PLOS ONE | 2 February 2013 | Volume 8 | Issue 2 | e56271 Impact of Aid on Maternal and Reproductive Health Figure 3. Flow diagram depicting the theorised impact of aid not delivered under the Paris principles. doi:10.1371/journal.pone.0056271.g003 Methods The protocol and full report for this systematic review are available online [8,9]. Eligibility Criteria Participants. Studies had to refer to developing countries or developing regions of the world (Participants). In our review developing countries are those categorised as ‘Medium Human Development’ and ‘Low Human Development’ in the Human Development Index of 2009 [10]. Intervention. Studies had to report on official development aid delivered according to the Paris aid effectiveness principles (which we call ‘Paris style aid’); this could mean any aid intervention underpinned by some or all of the five Paris principles. However, as the Paris principles are relatively new (adopted in 2005), many studies on aid projects and programmes aimed at addressing maternal and reproductive health do not use this terminology or are not explicit about whether the aid in question would conform to these principles. Moreover, no set definitions exist to denote what does and does not constitute Paris style aid. In order not to lose relevant studies, we devised a categorisation system which places aid modalities in a hierarchy. In our system, general budget support is the aid modality that most closely conforms to the Paris Principles as it is given directly to the central government of a recipient, with no directing of how it should be spent. It requires that the recipient has in place a robust national development strategy which is well managed and transparent. It is therefore underpinned by principles of ownership, alignment, mutual accountability and managing for results. Sector budget support and basket funds also adhere to the Paris Principles, but in a more constrained way, notably they are less ‘owned’ by the national government as donors retain considerable control over where aid is allocated, but are closely aligned with national plans, harmonised, and carrying strong respect for mutual accountability. Some types of project aid can also be considered to adhere to the Paris Principles, if they are sufficiently harmonised with that of other donors and if they are aligned with government plans, ideally with aid reported within the government budget (otherwise known as on-plan and on-budget). We might anticipate seeing this type of project aid within a sector-wide approach, where donors support a comprehensive sector policy led by the government. The aid provided by donors to a sector-wide approach can take any form. Other types of project aid cannot be said to adhere to the Paris Principles, namely when projects are managed and delivered outside country frameworks and financial systems (otherwise known as off-plan and off-budget). These we consider to be a proxy for non-Paris-style aid (i.e. ‘general aid’). See figure 4 for our aid hierarchy which includes detailed definitions of Paris style and general aid. Comparison. Studies had to report on official development aid not delivered according to the Paris principles (‘general aid’), i.e. aid interventions that are managed and delivered outside country frameworks and financial systems. The difficulty here is that some interventions may appear or lay claim to being aligned or harmonised. The key element which distinguishes between Parisstyle aid and general aid in our system is whether aid is ‘on-budget’ or not, i.e. reported within the budget of the recipient government. Outcomes. Studies had to evaluate the effect of aid on at least one of the six MDG 5 target indicators (United Nations website for the MDG indicators. Available: Host.aspx?Content=indicators/officiallist.htm. Accessed 2013 May 3): 1. MDG 5.1 maternal mortality rate or ratio; 2. MDG 5.2 proportion of births attended by skilled health personnel; 3. MDG 5.3 contraceptive prevalence rate among married women, aged 15–49; 4. MDG 5.4 adolescent birth rate; 5. MDG 5.5 ante-natal care coverage; 6. MDG 5.6 unmet need for family planning. The success or otherwise of the aid intervention would be demonstrated by changes in the MDG 5 target indicators, backed up by evidence. Study design. Studies had to present statistical evidence of the impact of aid on MDG 5 outcomes. Studies were categorised according to design as follows: – ‘causal’ studies: these would present causal impact data and would be based on experimental (randomised) or quasiexperimental research design, which we defined as nonrandomised designs used to test a causal hypothesis. ‘Causal’ studies would produce the strongest evidence of impact. – ‘correlation’ studies: these were defined by us as observational studies which test an association between the intervention and the outcome recorded and would come from non-experimental designs. ‘Correlation’ studies would give weaker evidence possibly suggestive of impact. PLOS ONE | 3 February 2013 | Volume 8 | Issue 2 | e56271 Impact of Aid on Maternal and Reproductive Health Figure 4. Hierarchy of aid modalities including definitions. doi:10.1371/journal.pone.0056271.g004 Search Strategy We designed a search strategy that involved a round of systematic searching for potentially eligible studies. We searched the following databases from 1990–2010 (this reflects the period during which a concerted effort was made to reform international aid management practices): Web of Science, Dissertations and Theses, Index to Theses, MEDLINE, EMBASE, Cinahl, Popline, Global Health Library (incorporating LILACS, AFRO, EMRO, PAHO, WHOLIS, WPRO), Econlit, IBSS, JOLIS, and IDEAS. Key organisation websites were trawled or, where feasible, searched using keyword searches (i.e. Google advanced searches): DFID, GFATM, OECD, PATH, USAID, UNIFEM, White Ribbon Alliance, World Bank, and World Health Organisation. Topic gateways were trawled or, where feasible, searched using keyword searches (i.e. Google advanced searches): ELDIS, BLDS, Aid Effectiveness Portal, and DFID Research 4 Development. Keyword searches were conducted using Internet search engines Google and Google Scholar. Reference lists were inspected from relevant existing evidence syntheses, systematic and literature reviews. Direct contact was PLOS ONE | 4 February 2013 | Volume 8 | Issue 2 | e56271 Impact of Aid on Maternal and Reproductive Health made with authors and experts working in the fields of maternal health and aid which yielded specialist recommendations. Due to limited resources, no hand searching of journals was undertaken. A full record of the search strategies used in this review is presented in the final report [9]. The search strategy used for Popline is presented here as an example: Popline ( searched 2010-08-08) (official development assistance/global health initiative*/global fund*/((aid/ donor) & (disbursement*/commitment*/flow*/international/ development/project*/program*))) & (maternal health/maternal health services/reproductive health/maternal mortality/family planning/contraceptive usage/adolescent pregnancy/(birth* & attend* & skill*)/(Millennium Development Goal* & 5)/MDG5/ MDG 5). Study Selection One reviewer (EMT) applied the eligibility criteria to the yield from the search activities beginning with the title and abstracts and, if the report was considered suitable, the full report. Data Extraction Data were extracted by a single reviewer (EMT), using a coding tool designed specifically for the review (presented in the final report) [9]. Data were sought under the following headings: general information, study details, aid information, contextual information, MDG focus, data, study findings and additional comments, and study claims. Quality Assessment A quality assessment was conducted by three reviewers (EMT, RH and FC). Disagreements were resolved by discussion. As no single approach to the assessment of quality and assessment of bias in studies evaluating the effect of international aid exists [11], we created a quality assessment tool, drawing on items used in previous reviews [12–15]. The tool posed questions to assess: study independence, the reporting of the aid intervention, the reporting of the study design and methods, the robustness of data analysis, and the reporting of confounding factors. All answers were categorised as yes/no/unclear, then used to rate studies as low, medium or high quality in each area (figure 5). The results were used to identify the risk of bias in each study (primarily with regards to study independence), potential weaknesses in the study design and findings, and for descriptive purposes, i.e. to determine the nature of the aid intervention described. The findings of the quality assessment were used to divide studies into two pools. ‘Pool A’ contained studies on interventions which demonstrated adherence to some or all of the Paris principles, while ‘Pool B’ contained studies classified as general aid either because there was no indication of adherence to the Paris principles or because the information was too limited to make a sound judgement. Quantitative Data Synthesis Where appropriate, we intended to re-calculate summary statistics for each study based on absolute numbers for each Figure 5. Quality assessment tool. equilibrium value of MeCpG steps (,+14 deg.) [31,44]. In comparison, methylation has a significantly lower stability cost when happening at major groove positions, such as 211 and 21 base pair from dyad (mutations 9 and 12), where the roll of the nucleosome bound conformation (+10 deg.) is more compatible with the equilibrium geometry of MeCpG steps. The nucleosome destabilizing effect of cytosine methylation increases with the number of methylated cytosines, following the same position dependence as the single methylations. The multiple-methylation case reveals that each major groove meth- PLOS Computational Biology | 3 November 2013 | Volume 9 | Issue 11 | e1003354 DNA Methylation and Nucleosome Positioning ylation destabilizes the nucleosome by around 1 kJ/mol (close to the average estimate of 2 kJ/mol obtained for from individual methylation studies), while each minor groove methylation destabilizes it by up to 5 kJ/mol (average free energy as single mutation is around 6 kJ/mol). This energetic position-dependence is the reverse of what was observed in a recent FRET/SAXS study [30]. The differences can be attributed to the use of different ionic conditions and different sequences: a modified Widom-601 sequence of 157 bp, which already contains multiple CpG steps in mixed orientations, and which could assume different positioning due to the introduction of new CpG steps and by effect of the methylation. The analysis of our trajectories reveals a larger root mean square deviation (RMSD) and fluctuation (RMSF; see Figures S2– S3 in Text S1) for the methylated nucleosomes, but failed to detect any systematic change in DNA geometry or in intermolecular DNA-histone energy related to methylation (Fig. S1B, S1C, S4–S6 in Text S1). The hydrophobic effect should favor orientation of the methyl group out from the solvent but this effect alone is not likely to justify the positional dependent stability changes in Figure 2, as the differential solvation of the methyl groups in the bound and unbound states is only in the order of a fraction of a water molecule (Figure S5 in Text S1). We find however, a reasonable correlation between methylation-induced changes in hydrogen bond and stacking interactions of the bases and the change in nucleosome stability (see Figure S6 in Text S1). This finding suggests that methylation-induced nucleosome destabilization is related to the poorer ability of methylated DNA to fit into the required conformation for DNA in a nucleosome. Changes in the elastic deformation energy between methylated and un-methylated DNA correlate with nucleosomal differential binding free energies To further analyze the idea that methylation-induced nucleosome destabilization is connected to a worse fit of methylated DNA into the required nucleosome-bound conformation, we computed the elastic energy of the nucleosomal DNA using a harmonic deformation method [36,37,44]. This method provides a rough estimate of the energy required to deform a DNA fiber to adopt the super helical conformation in the nucleosome (full details in Suppl. Information Text S1). As shown in Figure 2, there is an evident correlation between the increase that methylation produces in the elastic deformation energy (DDE def.) and the free energy variation (DDG bind.) computed from MD/TI calculations. Clearly, methylation increases the stiffness of the CpG step [31], raising the energy cost required to wrap DNA around the histone octamers. This extra energy cost will be smaller in regions of high positive roll (naked DNA MeCpG steps have a higher roll than CpG steps [31]) than in regions of high negative roll. Thus, simple elastic considerations explain why methylation is better tolerated when the DNA faces the histones through the major groove (where positive roll is required) that when it faces histones through the minor groove (where negative roll is required). Nucleosome methylation can give rise to nucleosome repositioning We have established that methylation affects the wrapping of DNA in nucleosomes, but how does this translate into chromatin structure? As noted above, accumulation of minor groove methylations strongly destabilizes the nucleosome, and could trigger nucleosome unfolding, or notable changes in positioning or phasing of DNA around the histone core. While accumulation of methylations might be well tolerated if placed in favorable positions, accumulation in unfavorable positions would destabilize the nucleosome, which might trigger changes in chromatin structure. Chromatin could in fact react in two different ways in response to significant levels of methylation in unfavorable positions: i) the DNA could either detach from the histone core, leading to nucleosome eviction or nucleosome repositioning, or ii) the DNA could rotate around the histone core, changing its phase to place MeCpG steps in favorable positions. Both effects are anticipated to alter DNA accessibility and impact gene expression regulation. The sub-microsecond time scale of our MD trajectories of methylated DNAs bound to nucleosomes is not large enough to capture these effects, but clear trends are visible in cases of multiple mutations occurring in unfavorable positions, where unmethylated and methylated DNA sequences are out of phase by around 28 degrees (Figure S7 in Text S1). Due to this repositioning, large or small, DNA could move and the nucleosome structure could assume a more compact and distorted conformation, as detected by Lee and Lee [29], or a slightly open conformation as found in Jimenez-Useche et al. [30]. Using the harmonic deformation method, we additionally predicted the change in stability induced by cytosine methylation for millions of different nucleosomal DNA sequences. Consistently with our calculations, we used two extreme scenarios to prepare our DNA sequences (see Fig. 3): i) all positions where the minor grooves contact the histone core are occupied by CpG steps, and ii) all positions where the major grooves contact the histone core are occupied by CpG steps. We then computed the elastic energy required to wrap the DNA around the histone proteins in unmethylated and methylated states, and, as expected, observed that methylation disfavors DNA wrapping (Figure 3A). We have rescaled the elastic energy differences with a factor of 0.23 to match the DDG prediction in figure 2B. In agreement with the rest of our results, our analysis confirms that the effect of methylation is position-dependent. In fact, the overall difference between the two extreme methylation scenarios (all-in-minor vs all-in-major) is larger than 60 kJ/mol, the average difference being around 15 kJ/ mol. We have also computed the elastic energy differences for a million sequences with CpG/MeCpG steps positioned at all possible intermediate locations with respect to the position (figure 3B). The large differences between the extreme cases can induce rotations of DNA around the histone core, shifting its phase to allow the placement of the methylated CpG steps facing the histones through the major groove. It is illustrative to compare the magnitude of CpG methylation penalty with sequence dependent differences. Since there are roughly 1.5e88 possible 147 base pairs long sequence combinations (i.e., (4n+4(n/2))/2, n = 147), it is unfeasible to calculate all the possible sequence effects. However, using our elastic model we can provide a range of values based on a reasonably large number of samples. If we consider all possible nucleosomal sequences in the yeast genome (around 12 Mbp), the energy difference between the best and the worst sequence that could form a nucleosome is 0.7 kj/mol per base (a minimum of 1 kJ/mol and maximum of around 1.7 kJ/mol per base, the first best and the last worst sequences are displayed in Table S3 in Text S1). We repeated the same calculation for one million random sequences and we obtained equivalent results. Placing one CpG step every helical turn gives an average energetic difference between minor groove and major groove methylation of 15 kJ/ mol, which translates into ,0.5 kJ/mol per methyl group, 2 kJ/ mol per base for the largest effects. Considering that not all nucleosome base pair steps are likely to be CpG steps, we can conclude that the balance between the destabilization due to CpG methylation and sequence repositioning will depend on the PLOS Computational Biology | 4 November 2013 | Volume 9 | Issue 11 | e1003354 DNA Methylation and Nucleosome Positioning Figure 3. Methylated and non-methylated DNA elastic deformation energies. (A) Distribution of deformation energies for 147 bplong random DNA sequences with CpG steps positioned every 10 base steps (one helical turn) in minor (red and dark red) and major (light and dark blue) grooves respectively. The energy values were rescaled by the slope of a best-fit straight line of figure 2, which is 0.23, to por la lectura a través de la lectura de la prensa. La educación en los medios las fuerzas dispersas en función de los soportes mediáticos y orientarse más hacia la educación en medios que al dominio adquiere pleno derecho y entidad en la sección sexta titulada «competencias sociales y cívi- técnico de los aparatos. cas» que indica que «los alum- nos deberán ser capaces de juz- gar y tendrán espíritu crítico, lo que supone ser educados en los las programaciones oficiales, ya que, a lo largo de un medios y tener conciencia de su lugar y de su influencia estudio de los textos, los documentalistas del CLEMI en la sociedad». han podido señalar más de una centena de referencias a la educación de los medios en el seno de disciplinas 4. Un entorno positivo como el francés, la historia, la geografía, las lenguas, Si nos atenemos a las cifras, el panorama de la las artes plásticas : trabajos sobre las portadas de educación en medios es muy positivo. Una gran ope- prensa, reflexiones sobre temas mediáticos, análisis de ración de visibilidad como la «Semana de la prensa y publicidad, análisis de imágenes desde todos los ángu- de los medios en la escuela», coordinada por el CLE- los, reflexión sobre las noticias en los países europeos, MI, confirma año tras año, después de 17 convocato- información y opinión rias, el atractivo que ejerce sobre los profesores y los Esta presencia se constata desde la escuela mater- alumnos. Concebida como una gran operación de nal (2 a 6 años) donde, por ejemplo, se le pregunta a complementariedad entre la escuela y los profesiona- los niños más pequeños si saben diferenciar entre un les de los medios, alrededor del aprendizaje ciudada- periódico, un libro, un catálogo, a través de activida- no de la comunicación mediática, este evento moviliza des sensoriales, si saben para qué sirve un cartel, un durante toda una semana un porcentaje elevado de periódico, un cuaderno, un ordenador si son capa- centros escolares que representan un potencial de 4,3 ces de reconocer y distinguir imágenes de origen y de millones de alumnos (cifras de 2006). Basada en el naturaleza distintas. Podríamos continuar con más voluntariado, la semana permite desarrollar activida- ejemplos en todos los niveles de enseñanza y práctica- des más o menos ambiciosas centradas en la introduc- Páginas 43-48 ción de los medios en la vida de la escuela a través de la instalación de kioscos, organización de debates con profesionales y la confección por parte de los alumnos de documentos difundidos en los medios profesionales. Es la ocasión de dar un empujón a la educación en medios y de disfrutarlos. Los medios –un millar en 2006– se asocian de maneras diversas ofreciendo ejemplares de periódicos, acceso a noticias o a imágenes, proponiendo encuentros, permitiendo intervenir a los jóvenes en sus ondas o en sus columnas Esta operación da luz al trabajo de la educación en medios y moviliza a los diferentes participantes en el proyecto. 5. La formación de los docentes La formación es uno de los pilares principales de la educación en los medios. Su función es indispensable ya que no se trata de una disciplina, sino de una enseñanza que se hace sobre la base del voluntariado y del compromiso personal. Se trata de convencer, de mostrar, de interactuar. En primer lugar es necesario incluirla en la formación continua de los docentes, cuyo volumen se ha incrementado desde 1981 con la aparición de una verdadera política de formación continua de personal. Es difícil dar una imagen completa del volumen y del público, pero si nos atenemos a las cifras del CLEMI, hay más de 24.000 profesores que han asistido y se han involucrado durante 2004-05. 5.1. La formación continua En la mayoría de los casos, los profesores reciben su formación en contextos cercanos a su centro de trabajo, o incluso en este mismo. Después de una política centrada en la oferta que hacían los formadores, se valora más positivamente la demanda por parte del profesorado, ya que sólo así será verdaderamente fructífera. Los cursos de formación se repartieron en varias categorías: desde los formatos más tradicionales (cursos, debates, animaciones), hasta actividades de asesoramiento y de acompañamiento, y por supuesto los coloquios que permiten un trabajo en profundidad ya que van acompañados de expertos investigadores y profesionales. Citemos, por ejemplo en 2005, los coloquios del CLEMI-Toulouse sobre el cine documental o el del CLEMI-Dijon sobre «Políticos y medios: ¿connivencia?». Estos coloquios, que forman parte de un trabajo pedagógico regular, reagrupan a los diferentes participantes regionales y nacionales alrededor de grandes temas de la educación en medios y permiten generar nuevos conocimientos de aproximación y una profundización. Páginas 43-48 Hay otro tipo de formación original que se viene desarrollando desde hace menos tiempo, a través de cursos profesionales, como por ejemplo, en el Festival Internacional de Foto-periodismo «Visa para la imagen», en Perpignan. La formación se consolida en el curso, da acceso a las exposiciones, a las conferencias de profesionales y a los grandes debates, pero añade además propuestas pedagógicas y reflexiones didácticas destinadas a los docentes. Estas nuevas modalidades de formación son también consecuencia del agotamiento de la formación tradicional en las regiones. Los contenidos más frecuentes en formación continua conciernen tanto a los temas más clásicos como a los cambios que se están llevando a cabo en las prácticas mediáticas. Así encontramos distintas tendencias para 2004-05: La imagen desde el ángulo de la producción de imágenes animadas, el análisis de la imagen de la información o las imágenes del J.T. La prensa escrita y el periódico escolar. Internet y la información en línea. Medios y educación de los medios. 5.2 La formación inicial La formación inicial está aun en un grado muy ini- cial. El hecho de que la educación en medios no sea una disciplina impide su presencia en los IUFM (Institutos Universitarios de Formación de Maestros) que dan una prioridad absoluta a la didáctica de las disciplinas. En 2003, alrededor de 1.400 cursillistas sobre un total de 30.000 participaron en un momento u otro de un módulo de educación en medios. Estos módulos se ofrecen en función del interés que ese formador encuentra puntualmente y forman parte a menudo de varias disciplinas: documentación, letras, historia-geografía Estamos aún lejos de una política concertada en este dominio. La optativa «Cine-audiovisual» ha entrado desde hace muy poco tiempo en algunos IUFM destinada a obtener un certificado de enseñanza de la opción audiovisual y cine. Internet tiene cabida también en los cursos de formación inicial, recientemente con la aparición de un certificado informático y de Internet para los docentes, dirigido más a constatar competencias personales que a valorar una aptitud para enseñarlos. 6. ¿Y el futuro? El problema del futuro se plantea una vez más por la irrupción de nuevas técnicas y nuevos soportes. La difusión acelerada de lo digital replantea hoy muchas cuestiones relativas a prácticas mediáticas. Muchos Comunicar, 28, 2007 47 Comunicar, 28, 2007 Enrique Martínez-Salanova '2007 para Comunicar 48 trabajos que llevan el rótulo de la educación en medios solicitan una revisión ya que los conceptos cambian. La metodología elaborada en el marco de la educación en medios parece incluso permitir la inclinación de la sociedad de la información hacia una sociedad del conocimiento, como defiende la UNESCO. En Francia, se necesitaría unir las fuerzas dispersas en función de los soportes mediáticos y orientarse más hacia la educación en medios que al dominio técnico de los aparatos. Los avances recientes en el reconocimiento de estos contenidos y las competencias que supondrían podrían permitirlo. Referencias CLEMI/ACADEMIE DE BORDEAUX (Ed.) (2003): Parcours médias au collège: approches disciplinaires et transdisciplinaires. Aquitaine, Sceren-CRDP. GONNET, J. (2001): Education aux médias. Les controverses fécondes. Paris, Hachette Education/CNDP. SAVINO, J.; MARMIESSE, C. et BENSA, F. (2005): L’éducation aux médias de la maternelle au lycée. Direction de l’Enseignement Scolaire. Paris, Ministère de l’Education Nationale, Sceren/CNDP, Témoigner. BEVORT, E. et FREMONT, P. (2001): Médias, violence et education. Paris, CNDP, Actes et rapports pour l’éducation. – fiches pédagogiques, rapports et liens avec les pages régionales/académiques. – Le site «Quai des images» est dédié à l’enseignement du cinéma et de l’audiovisuel. – la rubrique «Côté profs» a une entrée «education aux médias». – Programme européen d’éducation aux risques liés à Internet. dResedfeleexliobnuetsacón Páginas 43-48
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