Health Topics
- Women's Limited Choice and Availability of Modern Contraception at Retail Outlets and Public-Sector Facilities in Luanda, Angola, 2012–2015
Despite high rates of unintended pregnancy, access to a wide range of contraceptive methods, especially injectables and long-acting reversible contraceptives (LARCs), is severely limited in both public and private facilities. Knowledge of contraceptive choices is likewise limited, yet a substantial proportion of women are not using their preferred method among the methods they know of.
- New Ways of Approaching Indoor Residual Spraying for Malaria
Using health extension workers in Ethiopia as supervisors of the spray team reduced operational costs while maintaining quality. But rethinking IRS calls for (1) adapting equipment and procedures to ensure higher-quality spray applications, and (2) empowering decentralized targeting against malaria transmission foci.
- Vasectomy: A Long, Slow Haul to Successful Takeoff
Vasectomy use is plagued by low demand among men. Nevertheless, its compelling advantages make substantial investment worthwhile. On the supply side, a priority is to actively link vasectomy with service delivery approaches for the other highly effective long-acting and permanent clinical methods. Robust demand generation should include messaging specific to vasectomy, but should also draw on broader social and behavior change communication efforts increasingly aimed at engaging men in family planning.
- Limits of “Skills And Drills” Interventions to Improving Obstetric and Newborn Emergency Response: What More Do We Need to Learn?
A “skills and drills” intervention in 4 hospitals in Karnataka, India, produced modest improvement in provider knowledge and skills but not in actual response to obstetric and newborn emergencies. We explore possible explanations, which include (1) the need for a more intensive intervention; (2) other weaknesses in the health system; and (3) behavioral or organizational barriers related to hierarchical structures, roles, and team formation.
- Indoor Residual Spraying Delivery Models to Prevent Malaria: Comparison of Community- and District-Based Approaches in Ethiopia
Integrating indoor residual spraying into the institutionalized community-based health system in 5 districts was more efficient than the district-based model and did not compromise quality or compliance with environmental standards.
- Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo
The pilot study obtained Ministry of Health approval to allow medical and nursing students to provide the injectable contraceptive Sayana Press and other methods in the community, paving the way for other task-shifting pilots including self-injection of Sayana Press with supervision by the students as well as injection by community health workers.
- Strengthening Government Leadership in Family Planning Programming in Senegal: From Proof of Concept to Proof of Implementation in 2 Districts
Based on a previous pilot experience, in a next proof-of-implementation phase, district authorities enthusiastically assumed leadership and mobilized local resources to implement a simplified package of family planning interventions, with outside technical support. Comparing a 6-month baseline period with a 6-month implementation period, couple-years of protection increased from about 2,000 to about 4,000 (82% increase) in one district, and from nearly 6,000 to about 9,000 (56% increase) in the second. Longer implementation periods could further support institutionalization and sustainability.
- Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care in Karnataka, India: A Proof-of-Concept Study
Skills refresher training combined with emergency drills improved knowledge, skills, and confidence of providers but was not sufficient to improve diagnosis and management of maternal and newborn complications. Systems-level changes, including consistent availability of equipment and supplies, adequate human resource staffing, and supportive supervision, are likely needed to improve maternal and newborn outcomes.
- Key Role of Drug Shops and Pharmacies for Family Planning in Urban Nigeria and Kenya
Pharmacies and drug shops provide a rich opportunity for expanding family planning access to urban women, especially unmarried and younger women. In urban Nigeria and Kenya, drug shops and pharmacies were the major sources for most short-acting methods, including oral contraceptive pills, emergency contraceptives, and condoms.
- Referral Systems to Integrate Health and Economic Strengthening Services for People with HIV: A Qualitative Assessment in Malawi
Two types of referral systems were implemented in this low-resource context: (1) a simple paper-based system connecting clinical HIV and nutrition support to village savings and loans services, and (2) a complex mHealth-based system with more than 20 types of health, economic strengthening, livelihoods, and food security services. Clients reported the referrals improved their health and nutrition and ability to save money in both models but more with the simple model. Providers had difficulty using the mobile app under the mHealth system, even after repeated trainings, considerable ongoing technical assistance, and multiple rounds of revisions to the interface.