Table of Contents
EDITORIALS
- Antenatal Corticosteroids: Primum non nocere
Efforts continue—building on work of the UN Commission on Life-Saving Commodities for Women and Children—to expand use of antenatal corticosteroids in low-resource settings. We argue that until more is known on the balance of benefit versus harm, such promotion should be suspended.
- Time to Evolve Beyond Prototypical Community-Based Distribution (CBD) of Contraception?
CBD efforts have a definite role in a variety of country programming contexts. However, contemporary efforts need to strive for an expanded method mix, strong support and motivation of CBD agents, and robust integration with existing health systems.
VIEWPOINTS
- Regaining Momentum in Family Planning
Since the launch of the Family Planning 2020 initiative 5 years ago, 46 million more clients in the 69 poorest countries are using modern contraception—a tremendous accomplishment, albeit behind schedule to reach the 2020 global goal of 120 million. Family planning continues to be innovative, and as reflected in the recent 2018 International Conference on Family Planning in Rwanda, there is a newfound momentum behind the movement and a new generation of young leaders with powerful ideas, creativity, and passion who are stepping up to help propel family planning onward.
ORIGINAL ARTICLES
- Antenatal Corticosteroids for Women at Risk of Imminent Preterm Birth in 7 sub-Saharan African Countries: A Policy and Implementation Landscape Analysis
Countries have put in place some elements necessary for safe and effective antenatal corticosteroid (ACS) use, but significant challenges remain including: ensuring accurate gestational age determination, establishing clear treatment guidelines, strengthening provider capacity, incorporating obstetric indications for ACS use in national essential medicines lists, and collecting and using ACS-related data in the HMIS. Most importantly, the quality of maternal and newborn care, including specialized newborn care, needs improvement to ensure a strong foundation for the safe and effective use of ACS.
- Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process Evaluation
Midterm process evaluation results indicated that design and implementation failures hindered the program's success, notably: (1) the short-acting methods provided by community-based distributors (CBDs) offered limited choice; (2) the nominal revenue retained from selling the methods provided limited motivation for the volunteer CBDs; and (3) the model was poorly coordinated with the existing clinical service system, partly because of challenging systems issues. In the revised model, the CBDs will also provide subcutaneous injectables and emergency contraceptive pills, retain more revenue from contraceptive sales, and have better interaction with the existing system including conducting monthly mini-campaigns to increase visibility and attract more clients.
- Unpacking the “Black Box”: How an SMS-Based Continuing Medical Education Intervention Improved Medical Knowledge Among HIV Clinicians in Vietnam
Daily SMS quizzes sent to medical practitioners seem to act as a stimulus for further self-study when paired with access to additional readings and online courses, improving medical knowledge as a result.
- Experiences With the Levonorgestrel Intrauterine System Among Clients, Providers, and Key Opinion Leaders: A Mixed-Methods Study in Nigeria
Between September 2016 and December 2017, Marie Stopes International Organisation Nigeria introduced the LNG IUS in 16 Nigerian states to increase method choice. Just under 1,000 devices were inserted, representing less than 1% of all long-acting reversible contraceptives provided. Qualitative feedback from opinion leaders, providers, and LNG IUS users found important benefits to users and suggested coordinated demand- and supply-side activities, including user champions and supportive providers to generate interest in the method, would be needed for successful scale-up.
- mLearning in the Democratic Republic of the Congo: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App
Health worker knowledge and self-confidence in basic emergency obstetric and newborn care (BEmONC) increased significantly 3 months after introduction of the Safe Delivery App in intervention facilities compared with controls.
- Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda
Over 1 year, the NGO-led project provided more than 14,000 units of DMPA-SC, mostly in community settings and to a substantial proportion (43%) of young women. The share of injectables increased significantly, as did the volume of all methods provided, including short-acting, long-acting, and permanent methods.
- Implementing an Integrated Pharmaceutical Management Information System for Antiretrovirals and Other Medicines: Lessons From Namibia
Integrating patient and commodity data into one system while maintaining specialized functionality has allowed managers to monitor and mitigate stock-out risks more effectively, as well as provide earlier warning for HIV drug resistance.
FIELD ACTION REPORTS
- Strengthening and Institutionalizing the Leadership and Management Role of Frontline Nurses to Advance Universal Health Coverage in Zambia
Through a 12-month blended learning program, nurses and nurse-midwives leading low-resource health facilities at the community level improved their capacity to engage community members, increased their ability to lead frontline teams, strengthened their skills and confidence in technology use, and optimized investments in the community health system to achieve high-quality services.
- Implementation Research to Strengthen Health Care Financing Reforms Toward Universal Health Coverage in Indonesia: A Mixed-Methods Approach to Real-World Monitoring
Implementation research enabled stakeholders to formulate questions, assess implications of research results that informed changes in regulations and payment at the primary care level, and strengthen monitoring capacity. While the national health insurance system had some impact on performance of primary care facilities, individual providers remained unsatisfied because payment was largely based on factors outside of their control such as tenure and position, rather than their contributions to improved performance.
TECHNICAL NOTES
- Revisiting the Facility-Based Delivery Rate Formula in the Philippines for Better Local Health Governance and Services
When calculating local facility-based delivery rates, the standard measure based on place of birth excludes residents' facility births outside the municipality. In contrast, counting the facility births of all residents—regardless of whether they take place within or outside their home municipality—provides a more accurate population- or residence-based measure of use of services for that catchment area. This residence-based measure offers local governments a better understanding of coverage gaps by taking into account place of residence rather than place of birth.
SHORT REPORTS
- Novel Indoor Residual Spray Insecticide With Extended Mortality Effect: A Case of SumiShield 50WG Against Wild Resistant Populations of Anopheles arabiensis in Northern Tanzania
The new SumiShield 50WG insecticide, which possibly has longer duration of effectiveness than other indoor residual spray (IRS) formulations, has potential as an alternative IRS product for malaria vector control, particularly where resistance to other formulations has developed.
COMMENTARIES
Many low- and middle-income countries are moving to introduce HPV vaccine into their national immunization programs. To improve coverage, equity, and sustainability, public health officials and practitioners can use planning and implementation lessons learned, including successful school-based delivery strategies, innovative approaches to reach out-of-school girls, best practices for communication and social mobilization, and integration of services to reduce delivery cost. Policy makers, donors, and global partners should continue to consider ways to drive down costs of vaccine procurement.
The LNG IUS is one of the most effective forms of reversible contraception and has important noncontraceptive benefits but is currently not used at scale in any Family Planning 2020 focus country. A global working group developed a shared learning agenda to answer critical questions, harmonize approaches, avoid duplication, and facilitate introduction of the method within the context of informed choice.