More articles from EDITORIALS
- Is It Time to Move Beyond Visual Inspection With Acetic Acid for Cervical Cancer Screening?
Newly emerging low-cost molecular assays and improved visual tests for cervical cancer screening call into question the role of visual inspection with acetic acid (VIA). VIA-based screening continues to offer a low-cost, single-visit approach for screening. However, VIA is highly rater-dependent and has problematic accuracy. RNA, DNA, and protein tests are now available. They offer greater accuracy and the option for self-sampling, but the testing kits are expensive. As these new options continue to improve, the time to move beyond VIA is fast approaching.
- Evidence-Based Programs, Yes—But What About More Program-Based Evidence?
Policy makers and program managers are better enabled to draw relevant lessons from implementation research and program experience elsewhere when there is richer documentation on what was done and what key contextual factors may have influenced outcomes. Newly developed Program Reporting Standards from WHO provide helpful guidance on what is needed for optimally useful documentation.
- Global Health: Science and Practice … 5 Years In
Five years after launching Global Health: Science and Practice, we are seeing signs that we are helping to fill an important gap in program-related evidence. Looking forward, we seek to offer better coverage for topics that are relatively neglected in the global health literature and to publish more papers by authors based in low- and middle-income countries. We invite authors to submit manuscripts on global health programs grounded in evidence from research, evaluation, monitoring data, or experiential knowledge, and encourage readers to access and share our free articles to find scalable approaches and important lessons to inform programs and policy.
- At Last! Universal Health Coverage That Prioritizes Health Impact: The Latest Edition of Disease Control Priorities (DCP3)
Sadly, we face a vast sea of health problems in global health. Universal health coverage programming should prioritize interventions with the most health impact, but instead largely succumbs to emphasizing less impactful clinical curative services. In contrast, DCP3 provides an evidence-based template that prioritizes impact. Yet even the most basic and realistic DCP3 package comes at a formidable price.
- 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.
- Effective LARC Providers: Moving Beyond Training (Republication)
Effective and productive providers are the key to successful provision of long-acting reversible contraceptives (LARCs). But LARCs demand more of providers than short-acting resupply methods. In addition to sound training, key elements to developing highly productive providers of LARCs include a thorough understanding of the service delivery system context; selecting providers with the most potential, especially from mid-level cadres; strong mentoring and supportive supervision; and attention to the supply chain and to demand-side support.
- Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale
Because public health must operate at scale in widely diverse, complex situations, randomized controlled trials (RCTs) have limited utility for public health. Other methodologies are needed. A key conceptual backbone is a detailed “theory of change” to apply appropriate evidence for each operational component. Synthesizing patterns of findings across multiple methodologies provides key insights. Programs operating successfully across a variety of settings can provide some of the best evidence. Challenges include judging the quality of such evidence and assisting programs to apply it. WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues.
- Oxytocin: taking the heat
Oxytocin-in-Uniject satisfied the standards of its temperature-time indicator (TTI) in severe home storage conditions, although that required resupply every 30 days—a logistically onerous programmatic standard. Possible advances include: (1) incorporating TTIs with packaged batches of less expensive and more widely used conventional vials of oxytocin; (2) using TTIs calibrated more closely to the actual temperature sensitivity of oxytocin; and (3) researching whether a lower dose of oxytocin would be equally efficacious in preventing postpartum hemorrhage.
- Urban health: it's time to get moving!
The global health community should mainstream urban health and implement urban health programs to address the triple health burden of communicable diseases, noncommunicable diseases, and injuries in low- and middle-income countries.