Latest Articles
- Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening
Despite challenges in material and managerial support, some state-level consultants appear to have improved routine immunization programming through supportive supervision and capacity building of health facility staff as well as advocacy for timely dispersion of funds. This country-led, problem-focused model of development assistance deserves further consideration.
- Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population
In an isolated mountainous area of Guatemala with high maternal mortality, an NGO-sponsored approach engaged communities to operate local, culturally appropriate birthing facilities and is achieving high and equitable utilization. Likely success factors:
Community engagement and ownership
Close location of facilities
Perceived high quality of services
Engagement of traditional birth attendants in the birthing process and as advocates for facility use
- A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept
Use of the inserter was found to be safe, with high fundal placement in 82% of cases. Complete expulsion occurred in 7.5% of cases and partial expulsion was detected in 10%, comparable with rates in other studies using standard IUD insertion techniques. Further study and use of the dedicated inserter may reveal increased convenience and reduced risk of infection among users and could improve acceptability of postpartum IUD provision among providers.
- Social Entrepreneurship: A Case Study From Brazil
Through careful sourcing of commodities, cost-cutting efficiencies, and realistic pricing, 3 large contraceptive social marketing programs evolved into profit-making enterprises while continuing to make low-priced contraceptives available to low-income consumers on a substantial scale.
- Measurement of Health Program Equity Made Easier: Validation of a Simplified Asset Index Using Program Data From Honduras and Senegal
Piggy-backing on an existing representative household survey that includes an asset index, it is possible to assess the socioeconomic distribution of program beneficiaries at low cost. The typically large number of questions used to construct the asset index, however, deters many implementers from adopting this approach. This study demonstrates that the number of questions can be significantly reduced to a subset that takes only a few minutes to administer without substantially altering findings or policy recommendations. The relevant subset is country-specific and thus necessitates tailored country questionnaires.
- Abbreviating the Wealth Index to Measure Equity in Health Programs More Easily
Efforts to simplify the construction of the DHS wealth index are encouraged (while recognizing it is constructed differently in each country), but attempts to assess equity in health programs should bear in mind that it is not sufficient to calculate the wealth index just for the participants in the program. The quintile distributions can vary dramatically within sub-populations. Assessments of equity require knowledge of the distribution of potential participants as well as actual participants.
- Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study
Fathers and grandmothers who participated in separate nutrition dialogue groups supported mothers to improve infant feeding practices including dietary diversity, food consistency, and use of animal-source foods. Future studies should explore using a family-centered approach that engages mothers together with key household influencers.
- Mapping the Prevalence and Sociodemographic Characteristics of Women Who Deliver Alone: Evidence From Demographic and Health Surveys From 80 Countries
An estimated 2.2 million women surveyed in low- and middle-income countries between 2005 and 2015 gave birth alone. This practice was concentrated in West and Central Africa and parts of East Africa. Women who delivered with no one present were very poor, uneducated, older, and of higher parity. Experience from northern Nigeria suggests the practice can be reduced markedly by mobilizing religious and civil society leaders to improve community awareness about the critical importance of having an attendant present.
- Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries’ wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
- Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … at Scale?
Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.