Table of Contents
EDITORIALS
- Community Ownership in Primary Health Care—Managing the Intangible
Although enduringly intangible, community ownership is foundational to primary health care. This intangibility is a reminder of what programs can and should do (create space for dialogue, question their own choices, expand diversity in stakeholder voices making sense of program-induced changes, including through evaluation) and what they cannot do (manage someone else’s ownership).
- Counseling Is a Relationship Not Just a Skill: Re-conceptualizing Health Behavior Change Communication by India’s Accredited Social Health Activists
The capacity for India’s community health workers—accredited social health activists (ASHAs)—to promote healthy behaviors must be understood within the health system and community context. Their ability to influence health behaviors depends on the strength of their relationships with families and support they receive from the health system.
ORIGINAL ARTICLES
- A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia
Community-based maternal child health programs should foster a sense of community ownership to promote sustainability. In rural Zambia, health interventions should be accessible to target communities and clear roles should be established among stakeholders for effective governance.
- Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India
We identified how the quantity and quality of actions taken by community health workers can be refined to move from a one-size-fits-all model to a precision approach that stands to benefit the health of the mothers and newborns they support.
- Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials
Improved biomass stoves may not reduce indoor air pollution as much as is needed to have an impact on adverse birth outcomes.
- Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria
In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently.
- The Critical Role and Evaluation of Community Mobilizers in Polio Eradication in Remote Settings in Africa and Asia
Critical community health worker criteria are important for all community programs, including those focused on a single disease. Areas of importance include community engagement, local adaptation, and linkage with the health system—critical areas for current and future epidemics.
- Integrating Calcium Into Antenatal Iron-Folic Acid Supplementation in Ethiopia: Women’s Experiences, Perceptions of Acceptability, and Strategies to Support Calcium Supplement Adherence
In household trials of improved practices, rural Ethiopian women were motivated to adhere to antenatal calcium supplementation regimens, and tailored home-based strategies helped them overcome barriers such as regimen complexity, forgetfulness, side effects, and discouragement from others.
- What Makes a National Pharmaceutical Track and Trace System Succeed? Lessons From Turkey
Successful implementation of a pharmaceutical track and trace system depended on the political determination to eliminate reimbursement fraud, as well as establishing a pharmaceutical market dominated by a single payer, making reimbursement contingent on verified dispensing and prescription, and being flexible in adapting the system according to stakeholders’ needs.
- Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda
The quality of services provided is likely to affect contraceptive continuation. However, findings are strongly influenced by the quality measurement tools used, emphasizing the need for standardization.
- Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia
Women receiving implant insertion at the community level were significantly more likely to report keeping their implant for more than 3 years. Even when a referral or back-up system for removals existed, efforts to task-shift the provision of contraceptive implants may have inadvertently led to extended implant use.
- Practical Implications of Policy Guidelines: A GIS Model of the Deployment of Community Health Volunteers in Madagascar
Geographic information systems can be used to support informed decisions about practical issues related to implementing community health worker (CHW) programs. Demands placed on CHWs regarding expected population and surface area coverage and travel time to facilities need to be carefully considered to ensure they are rational and realistic.
- Private Providers’ Experiences Implementing a Package of Interventions to Improve Quality of Care in Kenya: Findings From a Qualitative Evaluation
Although private providers felt that social franchising, quality improvement interventions, and accreditation helped them to increase the quantity and quality of services in their facilities, the quality improvement process was viewed as prohibitively expensive, and the accreditation process often was complex and difficult to navigate without outside assistance.
- Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis
We provide a framework to quantify the use of electronic immunization registry systems at the facility level and results show the importance of behavioral and organizational factors in explaining their sustained use in Tanzania and Zambia.
- The All Babies Count Initiative: Impact of a Health System Improvement Approach on Neonatal Care and Outcomes in Rwanda
A health system improvement program combining facility readiness support, clinical training/mentoring, and improvement collaboratives increased quality improvement capacity, improved maternal and newborn quality of care, and reduced neonatal mortality. These results can be used to inform system improvement approach design to transform quality of care and outcomes for newborns.
- Where Do Caregivers Take Their Sick Children for Care? An Analysis of Care Seeking and Equity in 24 USAID Priority Countries
Understanding whether and where parents take sick children for care is critical to improve child health and survival. Stakeholders should use this information to ensure that resources are programmed effectively and that sectors complement one another to increase equitable access to high quality integrated management approaches for sick child care.
- A Qualitative Comparative Analysis of the Drivers of HIV Status Knowledge in Orphans and Vulnerable Children in Mozambique
We identified combinations of modifiable factors that HIV programs supporting orphans, vulnerable children, and their families may be able to act on to increase the proportion of beneficiaries who know their HIV status.
- Matching Development of Point-of-Care Diagnostic Tests to the Local Context: A Case Study of Visceral Leishmaniasis in Kenya and Uganda
We provide a new protocol to connect how findings from field research on the local health care setting in resource-limited regions can inform researchers that are working toward developing a new point-of-care diagnostic test for neglected tropical diseases.
REVIEWS
- Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries
We identified factors that may influence the relationship between information generation and improvement of health service delivery: governance (leadership, participatory monitoring, regular review of data); production of information (presentation of findings, data quality, qualitative data); and health information system resources (electronic health management information systems, organizational structure, training).
METHODOLOGIES
- Mask Reuse in the COVID-19 Pandemic: Creating an Inexpensive and Scalable Ultraviolet System for Filtering Facepiece Respirator Decontamination
We outline a simple, low-cost design—both scalable and adaptable worldwide—to decontaminate filtering facepiece respirators (FFRs) using ultraviolet bulbs and supplies found in most hardware stores. The setup will help health care workers safely reuse FFRs in light of the shortages during the COVID-19 pandemic.
FIELD ACTION REPORTS
- Using Patient-Reported Outcome Measures to Promote Patient-Centered Practice: Building Capacity Among Pediatric Physiotherapists in Rwanda
Tracking outcomes is integral to assessing effectiveness of health systems. Multimodal training was offered in the use of a contextually appropriate, patient-centered outcome measure in a low-resource setting. Results offer insights for designing future capacity-building programs.
RESOURCES
- Top 10 Resources in Global Surgery
This resource list could serve to orient those interested in global surgery and could be supplemented with resources advocating for global surgery from clinical, population health, or policy perspectives.
COMMENTARIES
Devoting scarce health resources to meet the family planning needs of pregnant, postabortion, and postpartum women during the first wave of the COVID-19 pandemic is an investment against higher health systems burdens during subsequent waves of the pandemic and a means to save lives and improve livelihoods.