More articles from EDITORIAL
- Human Resources for Health: The Best Learning, the Best Skill Mix, and the Most Impact
Acting in a difficult environment, constructive efforts to improve medical education in Zimbabwe included revised curricula, investing in faculty and improved teaching skills, competency-based learning, and modern technology. But an ideal approach to health systems strengthening would put more emphasis on primary care and prevention, equity, and the many other vital health cadres besides physicians.
- The Coming-of-Age of Subcutaneous Injectable Contraception
DMPA-SC is a contraceptive injectable formulation that provides women and couples another important voluntary family planning option. It offers characteristics that many women like, including cost and time savings, and has the potential to be delivered by a range of health care cadres in a variety of service delivery channels.
- Modeling Outputs Can Be Valuable When Uncertainty Is Appropriately Acknowledged, but Misleading When Not
While modeling approaches seek to draw on the best available evidence to project health impact of improved coverage of specific interventions, uncertainty around the outputs often remains. When the modeling estimates are used for advocacy, these uncertainties should be communicated to policy makers clearly and openly to ensure they understand the model's limits and to maintain their confidence in the process.
- Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings
Most countries with high maternal (and newborn) mortality have very limited resources, overstretched health workers, and relatively weak systems and governance. To make important progress in reducing mortality, therefore, they need to carefully prioritize where to invest effort and funds. Given the demanding requirements to effectively implement the maternal death surveillance and response (MDSR) approach, in many settings it makes more sense to focus effort on the known drivers of high mortality, e.g., reducing geographic, financial, and systems barriers to lifesaving maternal and newborn care.
- Routine Health Facility and Community Information Systems: Creating an Information Use Culture
Substantial progress has been made to strengthen health information systems, with most efforts focusing on digitization, improving data quality and analysis, and identifying problems. But the ultimate goal is using information to solve problems, which requires building an information use culture over time. How? Human-centered design, role modeling by senior managers in use of data, and incentive-based systems hold considerable promise.
- Long-Acting HIV Treatment and Prevention: Closer to the Threshold
Substantial progress has been made toward viable, practical long-acting approaches to deliver HIV treatment and prevention through: (1) continued improvements in long-acting antiretrovirals (ARVs); (2) better innovative delivery systems; and (3) collaboration of willing partners to advance new ARVs. More progress on those 3 fronts is still needed to arrive at the goal of optimized HIV treatment and prevention for all who would benefit—and of finally controlling the HIV epidemic.
- Reducing Sepsis Deaths in Newborns Through Home Visitation and Active Case Detection: Is it Realistic?
Severe bacterial infection remains one of the major causes of newborn deaths in low-income countries. A key challenge for reducing this burden is making definitive treatment more easily available. Active case detection through early postnatal home visits can work under trial conditions but is difficult to implement at scale under routine conditions. In many settings, making treatment available at peripheral-level primary health care facilities may be more feasible.
- Not Ready for Primetime: Challenges of Antenatal Ultrasound in Low- and Middle-Income Country Settings
Even under optimized trial conditions, antenatal ultrasound was difficult to implement in Equateur Province, DRC. Moreover, the broader study across 5 countries failed to find an impact on pregnancy outcomes. Use of antenatal ultrasound screening appears not to be ready for wide application in low- and middle-income countries.
- Can We Expect Results-Based Financing to Improve Quality of Care?
Performance-based incentives as currently employed appear poorly adapted for improving quality of clinical processes. They mainly measure structural items that, while easier to measure, are remote from actual clinical quality, and they could even perversely lead to heightened attention to those factors at the expense of clinical quality.
- Winners of the Consortium of Universities for Global Health–Global Health: Science and Practice Annual Student Manuscript Contest
The 2 inaugural winners of the CUGH–GHSP Annual Student Manuscript Contest describe (1) the American Mock World Health Organization model for engaging students in global health policy and diplomacy, and (2) a successful Indo-U.S. twinning model of global health academic partnership led by students.