Table of Contents
EDITORIALS
- Retaining Patients in Care: An Important but Neglected Challenge
A hospital-based follow-up program in Uganda helped improve retention of patients in care across a range of health problems. Although the specific approach may not be replicable in other settings, hospitals in Uganda and beyond should consider how they can improve retention of patients requiring long-term care, including for HIV, TB, malnutrition, and noncommunicable diseases.
- Scale and Ambition in the Engagement of Private Providers for Tuberculosis Care and Prevention
The tuberculosis (TB) community knows the importance of engaging private providers to reach critical TB targets, and knows how to engage successfully. The next challenge is to transition such efforts to government stewardship and financing in order to reach scale.
VIEWPOINTS
- Where Do We Go From Here? Defining an Agenda for Home-Based Records Research and Action Considering the 2018 WHO Guidelines
Recent WHO guidelines point to knowledge gaps about home-based records despite their widespread use. Future research should explore their impact on health outcomes, challenges including production costs and confidentiality breaches, the role of design in their use, and the business case for investing in them.
SYNTHESES
- Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)
A multi-partner effort in Uganda and Zambia employed a districtwide health systems strengthening approach, with supply- and demand-side interventions, to address timely use of appropriate, quality maternity care. Between 2012 and 2016, maternal mortality declined by approximately 40% in both partnership-supported facilities and districts in each country. This experience has useful lessons for other low-resource settings.
ORIGINAL ARTICLES
- Successfully Engaging Private Providers to Improve Diagnosis, Notification, and Treatment of TB and Drug-Resistant TB: The EQUIP Public-Private Model in Chennai, India
Based on a participatory program design that addressed the self-described needs of private providers, a local NGO offered the providers access to rapid diagnostics and support for notification and patient treatment including free anti-TB drugs. The model resulted in high provider participation, contributing more than 10% of the overall TB case notifications, and an 89% treatment success rate for drug-sensitive TB.
- Factors Affecting Continued Use of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC): A Secondary Analysis of a 1-Year Randomized Trial in Malawi
Community health workers can adequately provide DMPA-SC directly or train women on self-injection.
- Scaling Up Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Mozambique: A Case Study Applying the ExpandNet/WHO Framework
Facilitating factors for this community-level scale up in 35 districts included strong government support, local champions, and a national policy on preventing postpartum hemorrhage (PPH). Challenges included a lack of a systematic scale-up strategy, limited communication of the PPH policy, a shift from a universal distribution policy to application of eligibility criteria, difficulties engaging remote traditional birth attendants, and implementation of a parallel M&E system.
- Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda
Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.
FIELD ACTION REPORTS
- Identifying and Reengaging Patients Lost to Follow-Up in Rural Africa: The “Horizontal” Hospital-Based Approach in Uganda
Between 30% and 60% of hospital outpatient clinic patients were lost to follow-up. A defaulter-tracking service using performance-based remuneration for outreach workers, cutting across different clinical services, improved patient retention overall but varied by disease, with the poorest outcomes among patients with HIV.
- Rapid Integration of Zika Virus Prevention Within Sexual and Reproductive Health Services and Beyond: Programmatic Lessons From Latin America and the Caribbean
During the 2015–16 Zika virus outbreak, IPPF member association providers reached clients and affected populations faster by integrating critical information and services within existing sexual and reproductive health platforms. Challenges included: (1) communicating rapidly evolving evidence to providers; (2) overcoming restrictive social norms on gender and sexuality and a related lack of public messaging on preventing sexual transmission; and (3) addressing disability stigma and breaching service gaps to support children and caregivers affected by congenital Zika syndrome.
- VECTOS: An Integrated System for Monitoring Risk Factors Associated With Urban Arbovirus Transmission
To strengthen local surveillance of mosquito-borne viral diseases such as dengue and Zika, a multidisciplinary team developed an integrated web-based information system called VECTOS that captures geo-referenced entomological, epidemiological, and social data. The system has revealed previously unidentified features, such as specific neighborhoods, at persistently high risk.
- Incorporating Voluntary Medical Male Circumcision Into Traditional Circumcision Contexts: Experiences of a Local Consortium in Zimbabwe Collaborating With an Ethnic Group
The successful collaboration resulted in a male circumcision camp where 98% of the 672 boys and men ages 10 and up chose voluntary medical male circumcision (VMMC) while traditional practices were respected. Such collaborations may improve patient safety and increase VMMC uptake in sub-Saharan Africa.
COMMENTARIES
The IBP initiative, a WHO-based partnership of NGOs, civil society organizations, governments, academic institutions, and other implementing partners, promotes evidence-based global guidelines, tools, and other interventions for local application, and incorporates implementation experience and learning back into the global discourse.