Latest Articles
- Early pregnancy detection by female community health volunteers in Nepal facilitated referral for appropriate reproductive health services
Trained female community health volunteers provided low-cost urine pregnancy tests in their communities, leading to counseling and appropriate referrals for antenatal care, family planning, or comprehensive abortion care.
- Providing technical assistance to ministries of health: lessons learned over 30 years
Pursuing true country ownership for effective programs requires a long-term approach involving persistence, patience, keen understanding of counterparts' perspective, deference, building trust, focus on priorities, technical competence, and sustained optimism.
- As good as physicians: patient perceptions of physicians and non-physician clinicians in rural primary health centers in India
Non-physician clinicians (NPCs), including both specially trained medical assistants and physicians trained in India systems of medicine, perform similarly to physicians in terms of patient satisfaction, trust, and perceived quality, thus supporting the use and scale up of NPCs in primary care.
- Obesity as a public health problem among adult women in rural Tanzania
Even in rural areas of Tanzania, an early stage of the nutrition transition is underway: 3 times as many women were overweight or obese than were undernourished. Overweight and obese women mainly follow a diet characterized by high consumption of bread and cakes (usually fried or baked in oil), sugar, and black tea.
- Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception
This project in Zambia contributes to our understanding of the impact of community-based provision of injectables on method choice and uptake and of the costs of adding DMPA to an established community-based family planning program. The project also illustrates the importance of involving stakeholders from the outset, analyzing costs relevant to scale up, and engaging in policy change dialogue not at the end, but rather throughout project implementation.
- Routine immunization: an essential but wobbly platform
Despite their vital role, routine immunization programs are taken for granted. Coverage levels are poor in some countries and have stagnated in others, while addition of new vaccines is an additional stressor. We need to strengthen: (1) policy processes, (2) monitoring and evaluation, (3) human resources, (4) regular delivery and supply systems, (5) local political commitment and ownership, (6) involvement of civil society and communities, and (7) sustainable financing. Rebalancing immunization direction and investment is needed.
- Simulated clients reveal factors that may limit contraceptive use in Kisumu, Kenya
While the quality of family planning service delivery was often good, clients reported barriers including: excessively long waiting times, provider absences, informal fees, inappropriate pregnancy tests, misinformation, and provider disrespect. Improved monitoring and oversight of facility practices and examination of provider needs and motivations may increase quality of service.
- Use of modern contraception increases when more methods become available: analysis of evidence from 1982–2009
International data over 27 years show that as each additional contraceptive method became available to most of the population, overall modern contraceptive use rose. But in 2009 only 3.5 methods, on average, were available to at least half the population in surveyed countries. Family planning programs should strive to provide widespread access to a range of methods.
- Multiplicity in public health supply systems: a learning agenda
Supply chain integration—merging products for health programs into a single supply chain—tends to be the dominant model in health sector reform. However, multiplicity in a supply system may be justified as a risk management strategy that can better ensure product availability, advance specific health program objectives, and increase efficiency.
- The 6 domains of behavior change: the missing health system building block
Behavior is crucial throughout global health interventions. The discipline of behavior change offers distinct expertise needed across 6 different domains of behavior. Such expertise is in short supply, however. We will not have effective and sustainable health systems, nor achieve our ambitious global health goals, without seriously addressing behavior change.