Latest Articles
- 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.
- The Levonorgestrel Intrauterine System: A Pragmatic View of an Excellent Contraceptive
The levonorgestrel intrauterine system (LNG IUS) has major advantages and could be a “game-changer” in improving contraceptive choice and use. It faces important challenges, however, including: (1) high commodity cost; (2) often-strong provider resistance to IUDs and difficult programmatic requirements; (3) need for demand creation, including assessing if markedly reduced menstrual bleeding is attractive to clients; and (4) the many requirements for introducing any new contraceptive. A good next step would be a well-focused and multifaceted “learning introduction” to assess the LNG IUS’s potential in several low-income countries, with rapid scale-up if results are promising.
- Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India
Trained nurse mentors catalyzed quality improvements in facility-based maternal and newborn care by: (1) encouraging use of self-assessment checklists and team-based problem solving, (2) introducing case sheets to ensure adherence to clinical guidelines, and (3) strengthening clinical skills through on-site demonstrations and bedside teaching. Inadequate leadership and staffing were challenges in some facilities. Some social norms, such as client resistance to referral and to staying 48 hours after delivery, also impact quality and mandate community mobilization efforts.
- Monitoring and Evaluating the Transition of Large-Scale Programs in Global Health
Monitoring and evaluating large-scale global health program transitions can strengthen accountability, facilitate stakeholder engagement, and promote learning about the transition process and how best to manage it. We propose a conceptual framework with 4 main domains relevant to transitions—leadership, financing, programming, and service delivery—along with guiding questions and illustrative indicators to guide users through key aspects of monitoring and evaluating transition. We argue that monitoring and evaluating transitions can bring conceptual clarity to the transition process, provide a mechanism for accountability, facilitate engagement with local stakeholders, and inform the management of transition through learning.
- The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.
- Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso
The radio campaign reached a high proportion of mothers, but the impact on self-reported behaviors at midline was mixed. Some reported episodic behaviors such as care seeking for diarrhea and obtaining treatment for fast/difficult breathing improved more in intervention than control areas, but there was little or no difference between areas in reported habitual behaviors, such as exclusive breastfeeding, complementary feeding, hand washing with soap, and use of bed nets.
- Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana
Most respondents thought the number of ambulances insufficient and said they would rather use a taxi—perceived to be faster—in a medical emergency. Nevertheless, people generally had favorable attitudes of existing public ambulance services, although few knew of the toll-free emergency number and many thought it appropriate to use ambulances to transport corpses. Targeted public education, along with improved capacity of ambulance agencies to handle increased caseload, could improve use.
- Reduced Effectiveness of Contraceptive Implants for Women Taking the Antiretroviral Efavirenz (EFV): Still Good Enough and for How Long?
EFV clearly reduces effectiveness of implants. However, the reduced effectiveness still appears better compared with short-acting methods overall, at least for the initial period of implant use, and may be acceptable to many women. We need better data on effectiveness, especially over the long term and on whether ENG implants (Implanon) might be more effective than LNG implants (Jadelle). Communicating the risk of pregnancy to clients under these circumstances is very challenging. In the longer term, providing an alternative to EFV, such as dolutegravir, might solve this problem.
- The Levonorgestrel Intrauterine System: Reasons to Expand Access to the Public Sector of Africa
The levonorgestrel intrauterine system has: (1) excellent effectiveness, (2) high satisfaction levels, (3) non-contraceptive benefits, and (4) potential to help reinvigorate interest in intrauterine contraception. The time is ripe for ministries and donor agencies to work together to make the product widely available across Africa.