Cross-Cutting Topics
- Provider-generated barriers to health services access and quality still persist
Barriers to access and quality, such as long waits, disrespectful provider behavior, and medical barriers, continue to constrain health programs. Reducing them further requires a multipronged management approach that includes understanding and addressing provider behavior and the real problems providers face.
- “A cup of tea with our CBD agent … ”: community provision of injectable contraceptives in Kenya is safe and feasible
Community health workers can safely provide the injectable DMPA when appropriately trained and supervised. We also found a fivefold increase in contraceptive uptake—a finding that builds on evidence from other countries for supportive policy change.
- 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.
- 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.
- 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.
- Achieving better maternal and newborn outcomes: coherent strategy and pragmatic, tailored implementation
Maternal and newborn health program effort needs to: shift from mere contact to the actual content or substance of care; respond better to local context; ensure delivery of all key interventions needed during pregnancy, labor and delivery, and postnatally; and actively monitor performance to manage and improve programs.
- 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.
- mHealth innovations as health system strengthening tools: 12 common applications and a visual framework
This new framework lays out 12 common mHealth applications used as health systems strengthening innovations across the reproductive health continuum.
- Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability
Only 34% of hospitals have reliable electricity access in surveyed sub-Saharan African countries. However, analysis in 2 countries indicates modest improvements in electricity access over time. Ambitious plans to improve health service delivery in sub-Saharan Africa need to address this critical issue.
- Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh
This quasi-experimental study integrated family planning, including the Lactational Amenorrhea Method, into community-based maternal and newborn health care and encouraged transition to other modern methods after 6 months to increase birth-to-pregnancy intervals. Community-based distribution of pills, condoms, and injectables, and referral for clinical methods, was added to meet women's demand.