Latest Articles
- 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.
- Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis
In general, across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods of contraception instead of short-acting methods. Exceptions are Bangladesh, India, and possibly Haiti.
- Fertility Awareness Methods: Distinctive Modern Contraceptives
Fertility awareness methods—the Lactational Amenorrhea Method, the Standard Days Method, and the Two Day Method—are safe and effective, and they have important additional benefits that appeal to women and men. Including these modern contraceptives in the method mix expands contraceptive choice and helps women and men meet their reproductive intentions.
- Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study
Following the introduction of IUDs into the Ethiopian public health sector, use of the method increased from <1% in 2011 to 6% in 2014 in a sample of 40 health facilities. This shift occurred in the context of wide method choice, following provider training, provision of post-training supplies, and community-based awareness creation. The IUD was acceptable to a diverse range of clients, including new contraceptive users, those with little to no education, those from rural areas, and younger women, thus suggesting a strong latent demand for IUDs in Ethiopia.
- The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned
With the single-visit approach for cervical cancer prevention, women with positive “visual inspection of the cervix with acetic acid wash” (VIA) test results receive immediate treatment of the precancerous lesion with cryotherapy. The approach worked successfully for women with HIV in Ethiopia in secondary and tertiary health facilities, with high screening and cryotherapy treatment rates. Sustainability and appropriate scale-up of such programs must address wider health system challenges including human resource constraints and shortage of essential supplies.
- Results-Based Financing in Mozambique’s Central Medical Store: A Review After 1 Year
The RBF scheme, which paid incentives for verified results, steadily improved the CMS's performance over 1 year, particularly for supply and distribution planning. Key apparent success factors:
1) The CMS had full discretion over how to spend the funds
2) Payment was shared with and dependent on all staff, which encouraged teamwork.
3) Performance indicators were challenging yet achievable.
4) The quarterly payment cycle was frequent enough to be motivating.
Recommendations for future programs: focus on both quality and quantity indicators; strengthen results verification processes; and work toward institutionalizing the approach.
- Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda
Integrating contraceptive services into infant immunization services was effective, acceptable, and feasible without negatively affecting immunization uptake. Yet unmet need for contraception remained high, including among a substantial number of women who were waiting for menses to return even though, at 6 months or more postpartum, they were at risk of an unintended pregnancy. More effort is needed to educate women about postpartum return to fertility and to encourage those desiring to space or limit pregnancy to use effective contraception.
- 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