Cross-Cutting Topics
- Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea
An informatics system consisting of a mobile health application and business intelligence software was used for collecting and analyzing Ebola contact tracing data. This system offered potential to improve data access and quality to support evidence-based decision making for the Ebola response in Guinea. Implementation challenges included software limitations, technical literacy of users, coordination among partners, government capacity for data utilization, and data privacy concerns.
- Monitoring and Evaluating the Transition of Large-Scale Programs in Global Health
Monitoring and evaluating large-scale global health program transitions can strengthen accountability, facilitate stakeholder engagement, and promote learning about the transition process and how best to manage it. We propose a conceptual framework with 4 main domains relevant to transitions—leadership, financing, programming, and service delivery—along with guiding questions and illustrative indicators to guide users through key aspects of monitoring and evaluating transition. We argue that monitoring and evaluating transitions can bring conceptual clarity to the transition process, provide a mechanism for accountability, facilitate engagement with local stakeholders, and inform the management of transition through learning.
- The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.
- Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana
Most respondents thought the number of ambulances insufficient and said they would rather use a taxi—perceived to be faster—in a medical emergency. Nevertheless, people generally had favorable attitudes of existing public ambulance services, although few knew of the toll-free emergency number and many thought it appropriate to use ambulances to transport corpses. Targeted public education, along with improved capacity of ambulance agencies to handle increased caseload, could improve use.
- Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso
The radio campaign reached a high proportion of mothers, but the impact on self-reported behaviors at midline was mixed. Some reported episodic behaviors such as care seeking for diarrhea and obtaining treatment for fast/difficult breathing improved more in intervention than control areas, but there was little or no difference between areas in reported habitual behaviors, such as exclusive breastfeeding, complementary feeding, hand washing with soap, and use of bed nets.
- Care Groups II: A Summary of the Child Survival Outcomes Achieved Using Volunteer Community Health Workers in Resource-Constrained Settings
Care Group projects resulted in high levels of healthy behavior, including use of oral rehydration therapy, bed nets, and health care services. Accordingly, under-5 mortality in Care Group areas declined by an estimated 32% compared with 11% in areas with child survival projects not using Care Groups.
- Remote Sensing of Vital Signs: A Wearable, Wireless “Band-Aid” Sensor With Personalized Analytics for Improved Ebola Patient Care and Worker Safety
This wireless sensor technology, currently being field-tested in an Ebola Treatment Unit in Sierra Leone, monitors multiple vital signs continuously and remotely. When connected with enhanced analytics software, it can discern changes in patients’ status much more quickly and intelligently than conventional periodic monitoring, thus saving critical health care worker time and reducing exposure to pathogens.
- The Demographic Stretch of the Arc of Life: Social and Cultural Changes That Follow the Demographic Transition
The demographic transition from high to low levels of mortality and fertility brings about changes that stretch the “arc of life,” making each stage of life longer and creating new ones—a phenomenon we call “the demographic stretch.” This stretch can transform societal structure, for example, by extending childhood, shifting working ages up, delaying marriage and childbearing, improving women’s status and equity, and pushing the burden of chronic disease and disability to older ages. Global health efforts must address the resultant economic and social changes.
- Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings
Care Groups use volunteers to motivate mothers to adopt key MCH behaviors. The volunteers meet as a group every 2–4 weeks with a paid facilitator to learn new health promotion messages. Key ingredients of the approach include: peer-to-peer health promotion, selection of volunteers by the mothers, a manageable workload for the volunteers (no more than 15 households per volunteer), frequent (at least monthly) contact between volunteers and mothers, and regular supervision of the volunteers.
- Task Sharing Implant Insertion by Community Health Workers: Not Just Can It Work, but How Might It Work Practically and With Impact in the Real World
Demonstrating that a health service, such as providing contraceptive implants, can be safely task shared to less highly trained workers is crucial but is only one step toward effective implementation at scale. Providers need dedicated time, enough clients, supplies, supervision, and other system support, allowing them to maintain their competency, confidence, and productivity.