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Across the 10 countries, 77% of 921,918 women left with a contraceptive method after receiving abortion care. While contraceptive uptake was high among all age groups, adolescents ages 15–19 were less likely to choose a method than women 25 years or older.
- Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia
Between 2009 and 2015, 1.2 million women received Implanon implants from trained Health Extension Workers. Of the approximately 7,000 implant service visits made during the first 6 months, 25% were among women who had never used contraception before.
- Food Security and Nutrition Outcomes of Farmer Field Schools in Eastern Democratic Republic of the Congo
A farmer field school program in food-insecure areas had positive impacts on household food security but not child nutritional status. Similar agricultural interventions may benefit food security, but the more difficult-to-achieve improvements in child nutrition status may require more focused and integrated programming approaches.
- Equal Opportunity, Equal Work: Increasing Women's Participation in the U.S. President's Malaria Initiative Africa Indoor Residual Spraying Project
Promotion of gender policies led to increased hiring of women in supervisory roles in a large indoor residual spraying (IRS) program with no meaningful differences in IRS output between men and women spray operators.
- Maternal and Neonatal Directed Assessment of Technologies (MANDATE): Methods and Assumptions for a Predictive Model for Maternal, Fetal, and Neonatal Mortality Interventions
MANDATE is a mathematical model designed to estimate the relative impact of different interventions on maternal, fetal, and neonatal lives saved in sub-Saharan Africa and India. A key advantage is that it allows users to explore the contribution of preventive interventions, diagnostics, treatments, and transfers to higher levels of care to mortality reductions, and at different levels of penetration, utilization, and efficacy.
- Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects
Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs.
- Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes
When providers in 6 different countries were asked how they would care for the same patient, there was wide variation within and between countries. Nevertheless, 11% of the physicians scored over 80%, suggesting good quality of care is possible even with resource constraints. Use of validated clinical vignettes, which can be applied affordably at scale, could help improve quality of services in low- and middle-income countries.
- National Assessment of Data Quality and Associated Systems-Level Factors in Malawi
Nearly all facility registers were available and complete. But accuracy varied, with antenatal care and HIV testing and counseling performing the best and family planning and acute respiratory infections data less well. Most facilities visibly displayed routine health data and most hospitals and district health offices had staff trained in health management information systems, but training was lacking at the facility level as were routine data quality checks and regular supervision.
- Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi
Use of simple wall charts by community and facility health workers to collect and visualize data helped inform data-based decision making for community health education activities, tracking stock-outs, staffing decisions, and other programming issues. Since intervention scale-up, however, use of the wall chart has dropped, demonstrating need for continued investment in supportive supervision.
- Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned
A national coordinating structure was established but encountered significant challenges including: (1) a low number of estimated maternal deaths identified that only included some occurring within facilities, (2) only half of those identified were reviewed, (3) reviewers had difficulties assessing the cause of death largely because of limited documentation in clinical records; and (4) resulting actions were limited. Successful implementation will require addressing many issues, including building support for the process lower down in the health system.