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Articles 1 - 30 of 1206
Full-Text Articles in Medicine and Health Sciences
Frontline Health Achievements In Harmonizing Measurement And Generating Evidence On Community Health System Performance, Frontline Health Project
Frontline Health Achievements In Harmonizing Measurement And Generating Evidence On Community Health System Performance, Frontline Health Project
Reproductive Health
As the global health community demonstrates an increasing commitment to investing in community health workers (CHWs) to achieve universal health coverage in lower- and middle-income countries, the need to effectively measure community health system performance is paramount. Embedded in the Integrating Community Health partnership (2017–2021), with support from the Bill & Melinda Gates Foundation, the Population Council and Last Mile Health co-led the Frontline Health (FLH) project, a four-year research, policy, and advocacy initiative aimed at developing core metrics and CHW reform processes, advancing their adoption, and promoting institutionalization of robust community health policies. This brief describes the Population Council’s …
Health And Ideations Of Married Female Adolescents, Breakthrough Research
Health And Ideations Of Married Female Adolescents, Breakthrough Research
Reproductive Health
This brief provides rigorous evidence-based insights to implementers and researchers of social and behavior change (SBC) programs that seek to improve knowledge, attitudes, norms, and behaviors of married female adolescents. The brief focuses on married adolescents’ uptake of services and health knowledge in Kebbi, Sokoto, and Zamfara states in northwestern Nigeria using a subset of data from a household survey of married women ages 15–49 years. It is one of a series of briefs that present findings from a Breakthrough RESEARCH study that uniquely captures data on a wide range of psychosocial drivers of behavioral outcomes in the areas of …
Using Social Listening To Inform Integrated Social And Behavior Change Programs In Burkina Faso, Nrupa Jani, Leanne Dougherty, Martha Silva
Using Social Listening To Inform Integrated Social And Behavior Change Programs In Burkina Faso, Nrupa Jani, Leanne Dougherty, Martha Silva
Reproductive Health
No abstract provided.
Management Of Intimate Partner Violence In Health Care Settings: A Training Manual For Health Care Providers, Division Of Reproductive And Maternal Health
Management Of Intimate Partner Violence In Health Care Settings: A Training Manual For Health Care Providers, Division Of Reproductive And Maternal Health
Reproductive Health
Intimate partner violence (IPV) is any behavior by an intimate partner that causes physical, sexual, or psychological harm. In healthcare settings where providers are well trained, caring, and sensitive, most survivors respond positively to being asked about their exposure to violence. Healthcare providers are in a unique position to identify survivors and offer appropriate management and referrals. The World Health organization developed clinical guidelines to provide evidence-based guidance to healthcare providers on the identification and appropriate response to IPV and sexual violence. Based on this guidance, the Ministry of Health developed a comprehensive training manual to empower healthcare providers with …
Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: Evidence Brief, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee
Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: Evidence Brief, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee
Reproductive Health
Despite intensified efforts to conduct research globally that informs strategies to address female genital mutilation (FGM), there has been limited rigorous high-quality evidence on interventions that are effective in ending the practice. As we begin the final decade of acceleration toward zero new cases of FGM by 2030, increasing the rigor, relevance, and utility of research for programming, policy development, and resource allocation is critical. This brief highlights key findings from an evidence review that synthesized and assessed the quality and strength of existing evidence on FGM interventions from 2008 to 2020. A number of studies have collated evidence on …
Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: A Review Of Evidence, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee
Effectiveness Of Interventions Designed To Prevent Or Respond To Female Genital Mutilation: A Review Of Evidence, Dennis Matanda, Melanie Croce-Galis, Jill Gay, Karen Hardee
Reproductive Health
Girls are one-third less likely to be subjected to female genital mutilation (FGM) today than 30 years ago. However, rapid population growth in some of the world’s poorest countries, where FGM persists, threatens to roll back progress. In 2020 alone, an estimated 4.1 million girls were at risk of being subjected to FGM. Without concerted and accelerated actions to end the practice, an estimated 68 million additional girls will have been subjected to FGM by 2030. Despite intensified global research efforts to inform strategies to address FGM, there has been little synergy between evidence generation and the implementation of programs …
Issues For Consideration In The Scale-Up Of The Inclusion Of Family Planning In The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah
Issues For Consideration In The Scale-Up Of The Inclusion Of Family Planning In The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah
Reproductive Health
Ghana is working toward achieving universal health coverage (UHC). This is driven, in part, by the Sustainable Development Goals (SDGs), specifically SDG 3—Good Health and Well-Being, which seeks to ensure healthy lives and promote well-being for all at all ages. Achieving this feat will improve equity of access as people, especially the poor can access quality health services without financial hardships. Ensuring equitable access to family planning (FP) is essential to securing the well-being of women and supporting the health and development of communities. One pathway to ensuring equity is the inclusion of FP in affordable insurance. While the inclusion …
Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana: A Health Facility Assessment, Population Council, Ministry Of Health, Ghana Health Service, National Health Insurance Authority, Marie Stopes International Ghana
Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana: A Health Facility Assessment, Population Council, Ministry Of Health, Ghana Health Service, National Health Insurance Authority, Marie Stopes International Ghana
Reproductive Health
In Ghana, National Health Insurance Act 852 of 2012 ensures that health-care benefits include family planning (FP) services, however people continue to pay for FP services because the policy is yet to be implemented in practice. Under the leadership of the Ministry of Health, the National Health Insurance Authority in collaboration with the Ghana Health Service, Marie Stopes International-Ghana and the Population Council implemented a pilot project to remove FP service out-of-pocket costs. All modern clinical FP methods were added to national health insurance and expensed by health facilities through the national health insurance claims process. The intervention significantly increased …
Considerations And Guidance For Using Routine And Program Monitoring Data For Social And Behavior Change Evaluation, Breakthrough Research
Considerations And Guidance For Using Routine And Program Monitoring Data For Social And Behavior Change Evaluation, Breakthrough Research
Reproductive Health
This brief is intended for global, regional, and national social and behavior change program implementers, evaluators, and monitoring and evaluation teams who want to document their program impacts through routinely collected data. Use of routine and program monitoring data for evaluation presents many opportunities for evaluating program impacts on priority health outcomes, with advantages that include their greater frequency, broader geographic range, longer duration, and lower cost of acquisition. Routine and program monitoring data may not be under direct control of evaluators and thus may not always be appropriate for evaluation. Careful consideration of the appropriateness of routine data for …
Advancements In Postpartum Hemorrhage Care (Apphc): Overview Of Portfolio Development And Research Studies In Malawi, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Advancements In Postpartum Hemorrhage Care (Apphc): Overview Of Portfolio Development And Research Studies In Malawi, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Reproductive Health
Advancements in Postpartum Hemorrhage Care (APPHC) is a catalytic investment by USAID to accelerate reductions in maternal deaths in Madagascar and Malawi. This brief outlines the portfolio of research activities in Malawi.
Advancing Postpartum Hemorrhage Care (Apphc): Partnership Approach And Portfolio Overview, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Advancing Postpartum Hemorrhage Care (Apphc): Partnership Approach And Portfolio Overview, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Reproductive Health
USAID has reinforced its longstanding efforts to accelerate reductions in maternal deaths with a catalytic investment in Malawi and Madagascar, Advancing Postpartum Hemorrhage Care (APPHC). This brief presents APPHC investment partnership, its approach, and expected results. The APPHC Partnership’s agenda and portfolio intensify the two major health system bilateral projects funded by USAID: Organized Network of Services for Everyone (ONSE) in Malawi and Accessible Continuum of Care and Essential Services Sustained (ACCESS) in Madagascar. These large implementation investments, with existing collaborations with ministries of Health and other key figures, offer optimal opportunities for embedding APPHC activities. The APPHC Partnership seeks …
Costing Social And Behavior Change Programming: The Role Of The Denominator, Breakthrough Research
Costing Social And Behavior Change Programming: The Role Of The Denominator, Breakthrough Research
Reproductive Health
This is the first in a series of brief reports intended to complement Breakthrough RESEARCH's Costing Guidelines and support a social and behavior change community of practice by discussing important issues and practices for social and behavior change costing. Breakthrough RESEARCH is gathering, analyzing, and sharing evidence on the costs and impact of social and behavior change interventions to support social and behavior change investments, which are crucial for improving health and advancing development. A review of costing literature identified 147 studies on social and behavior change costs, methodological shortcomings, and knowledge gaps that can be addressed in new costing …
Advancements In Postpartum Hemorrhage Care (Apphc): Overview Of Portfolio Development And Research Studies In Madagascar, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Advancements In Postpartum Hemorrhage Care (Apphc): Overview Of Portfolio Development And Research Studies In Madagascar, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Reproductive Health
Advancements in Postpartum Hemorrhage Care (APPHC) is a catalytic investment by USAID in Malawi and Madagascar to accelerate reductions in maternal deaths. This program brief presents APPHC’s portfolio of research activities in Madagascar.
Findings From The Merci Mon Héros Social Listening Endline Report, Breakthrough Research
Findings From The Merci Mon Héros Social Listening Endline Report, Breakthrough Research
Reproductive Health
No abstract provided.
Evaluating The Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah
Evaluating The Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah
Reproductive Health
Contraceptive use in Ghana has remained low despite annual increases since 2012. Having a high unmet need for family planning (FP) suggests that there may be barriers to access and uptake. Over time, several policies, including Ghana’s Costed Implementation Plan from 2015–20, have suggested FP initiatives to improve contraceptive use yet they have not been entirely implemented. Further, although FP was included in the health insurance act passed in 2003, amended in 2008, and revised in 2012, which indicated that health-care benefits include FP, people continue to pay out of pocket for services at National Health Insurance Authority facilities because …
Assessing Community Capacity Strengthening To Sustain Integrated Social Behavior Change Programming In Northwestern Nigeria, Breakthrough Research
Assessing Community Capacity Strengthening To Sustain Integrated Social Behavior Change Programming In Northwestern Nigeria, Breakthrough Research
Reproductive Health
Qualitative research by Breakthrough RESEARCH is evaluating efforts to prepare communities, through a community capacity strengthening approach, to sustain community social and behavior change programming to promote healthy family behaviors in northwestern Nigeria. This community capacity strengthening approach, implemented by Breakthrough ACTION Nigeria, engages local leaders and community organizations—specifically Ward Development Committees (WDCs)—to increase community capacities to coordinate local health systems to strengthen services and promote positive social norms and individual behaviors for improved health outcomes.
Practice-Based Learning: Medico-Legal Evidence Collection As Part Of Post-Rape Care In Refugee Contexts, Michael Gaitho, Ronald Kotut, Anne Ngunjiri, Jane T. Thiomi, Josephine Ngebeh, Chi-Chi Undie
Practice-Based Learning: Medico-Legal Evidence Collection As Part Of Post-Rape Care In Refugee Contexts, Michael Gaitho, Ronald Kotut, Anne Ngunjiri, Jane T. Thiomi, Josephine Ngebeh, Chi-Chi Undie
Reproductive Health
Health care providers collect an array of documentation and specimens to support criminal investigations. Such documentation and specimens are referred to as “medico-legal” or “forensic” evidence, and in the case of rape, include a survivor’s documented injuries and emotional state at the time of examination, as well as samples and specimens from the survivor’s body or clothing. For survivors of rape and defilement who want to obtain legal justice, medico-legal evidence is critical. In African countries, health providers and the police are depended upon to ensure such evidence is collected, but medico-legal evidence collection can present challenges. Evidence-based interventions are …
Practice-Based Learning: Establishing Simple Monitoring Systems To Support Sgbv Programming In Refugee Settings, Chi-Chi Undie, Josephine Ngebeh, Jane Harriet Namwebya, Michael Gaitho, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo
Practice-Based Learning: Establishing Simple Monitoring Systems To Support Sgbv Programming In Refugee Settings, Chi-Chi Undie, Josephine Ngebeh, Jane Harriet Namwebya, Michael Gaitho, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo
Reproductive Health
Implementers of sexual and gender-based violence programs in refugee settings are typically eager to learn about the extent to which their programs are making a difference in the lives of those they serve. Basic monitoring information can help address this imperative without unduly burdening program implementers with time-consuming evaluations. The Sauti/VOICE project is guiding adaptation and implementation of evidence-based SGBV interventions in refugee contexts. These interventions are implemented by UNHCR partners in eight countries in the East, Horn, and Great Lakes region of Africa. Although Sauti/VOICE is primarily focused on integrating tested SGBV interventions into refugee contexts, monitoring the implementation …
Documenting Lessons From An Integrated Social And Behavior Change Program Linked To Integrated Health Services In Zambia, Breakthrough Research
Documenting Lessons From An Integrated Social And Behavior Change Program Linked To Integrated Health Services In Zambia, Breakthrough Research
Reproductive Health
This program brief documents lessons for social and behavior change programmers implementing multi-health, community-based programs with integrated health services. An iterative process by Breakthrough ACTION Zambia, from October 2018 through March 2019, identified four design concepts with strong feasibility and potential for impact and expansion. These four concepts were refined in Breakthrough ACTION Zambia provinces and districts in collaboration with implementing partners and the Ministry of Health Department of Health Promotion, with final intervention design and implementation processes determined in close collaboration with the Ministry.
Modeling The Impact Of Inclusion Of Family Planning Services In Ghana's National Health Insurance Scheme, Justin Archer, Gillian Eva, Augustine Ankomah, Saumya Ramarao, Kamil Fuseini, Anne Coolen, Stephen Duku, Benjamin Bellows
Modeling The Impact Of Inclusion Of Family Planning Services In Ghana's National Health Insurance Scheme, Justin Archer, Gillian Eva, Augustine Ankomah, Saumya Ramarao, Kamil Fuseini, Anne Coolen, Stephen Duku, Benjamin Bellows
Reproductive Health
While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the …
Asking And Telling: An Assessment Of The Feasibility Of Screening Children For Sexual Violence In Kenyan School And Health Facility Contexts, Chi-Chi Undie, Margaret Mak'anyengo
Asking And Telling: An Assessment Of The Feasibility Of Screening Children For Sexual Violence In Kenyan School And Health Facility Contexts, Chi-Chi Undie, Margaret Mak'anyengo
Reproductive Health
Although sexual violence against children is increasingly prevalent in Kenya, documented and tested interventions for proactively identifying child survivors and providing them with care are currently nonexistent. This study aimed to determine the feasibility of screening children for SV in both school and health facility settings, and of providing child survivors identified through this process with access to care. The four-component intervention, implemented from January through April 2017, involved parent dialogues; student sensitization; provider training to administer a child-friendly screening tool and respond to child survivors; and SV screening, paired with SV service provision. As noted in this report, the …
Barriers Inhibiting Detection And Management Of Postpartum Hemorrhage By Providers In Madagascar, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Barriers Inhibiting Detection And Management Of Postpartum Hemorrhage By Providers In Madagascar, Breakthrough Research, Usaid's Health Evaluation And Applied Research Development
Reproductive Health
Breakthrough RESEARCH partner ideas42 conducted research in June 2019 in peri-urban and rural areas of Vohipeno and Manakara districts of Madagascar's Vatovavy-Fitovinany region to identify health care providers' challenges for detecting and managing complications during childbirth including postpartum hemorrhage and identify optimal solutions. This brief summarizes the results of a behavioral diagnosis that reveals “Facility-based providers do not consistently follow best practices for the detection and management of complications during childbirth.” Low perception of risk of postpartum hemorrhage, limited review of compliance with best practices, consequences of current practices, and resource scarcity can negatively affect provider decision-making and clinical practice.
Obstacles Limitant La Détection Et La Prise En Charge De L’Hpp Par Les Prestataires De Soins De Santé À Madagascar, Breakthrough Research
Obstacles Limitant La Détection Et La Prise En Charge De L’Hpp Par Les Prestataires De Soins De Santé À Madagascar, Breakthrough Research
Reproductive Health
Breakthrough RESEARCH partner ideas42 conducted research in June 2019 in peri-urban and rural areas of Vohipeno and Manakara districts of Madagascar's Vatovavy-Fitovinany region to identify health care providers' challenges for detecting and managing complications during childbirth including postpartum hemorrhage and identify optimal solutions. This brief summarizes the results of a behavioral diagnosis that reveals “Facility-based providers do not consistently follow best practices for the detection and management of complications during childbirth.” Low perception of risk of postpartum hemorrhage, limited review of compliance with best practices, consequences of current practices, and resource scarcity can negatively affect provider decision-making and clinical practice.
Important Lessons On Fgm/C Abandonment From Four Research Studies In Egypt, Nada Wahba, Nahla G. Abdel-Tawab, Abeer Salem
Important Lessons On Fgm/C Abandonment From Four Research Studies In Egypt, Nada Wahba, Nahla G. Abdel-Tawab, Abeer Salem
Reproductive Health
Female genital mutilation/cutting (FGM/C) continues to be a widespread practice in Egypt. According to the 2014 Egypt Demographic and Health Survey, the prevalence of FGM/C was 92 percent among ever-married women aged 15–49. However, Egypt continues to witness a drastic surge in the medicalization of FGM/C, with 74 percent of women aged 19 years and younger circumcised by medical practitioners, compared to 55 percent in 1995. This policy brief provides key results and recommendations of four studies conducted by the Population Council/ Egypt under the Evidence to End FGM/C project, in coordination with Egypt’s National Population Council. The four studies …
Commentary: Using Law More Effectively Towards Abandonment Of Fgm/C In Kenya, Agnes K. Meroka-Mutua
Commentary: Using Law More Effectively Towards Abandonment Of Fgm/C In Kenya, Agnes K. Meroka-Mutua
Reproductive Health
Female genital mutilation/cutting (FGM/C) is considered a harmful cultural practice and a form of violence against women. Kenya has an FGM/C prevalence rate of 21 percent, but levels vary by ethnic group. Kenya has adopted a robust legal framework for the prohibition of FGM/C, including passage of the Prohibition of FGM Act in 2011, a detailed law that criminalizes carrying out FGM/C and associated offenses. Kenya relies on the human rights–based approach and criminalization in its legal framework for the prohibition of this practice. Despite extensive legal provisions, Kenya has prosecuted fewer than 100 cases, raising concerns with the law’s …
Lessons From A Five-Year Research Programme On Fgm/C And Their Relevance For Policy And Programmes In Kenya, Dennis Matanda, Agnes K. Meroka-Mutua, Samuel Kimani
Lessons From A Five-Year Research Programme On Fgm/C And Their Relevance For Policy And Programmes In Kenya, Dennis Matanda, Agnes K. Meroka-Mutua, Samuel Kimani
Reproductive Health
The Sustainable Development Goals target the elimination of all forms of harmful practices, including female genital mutilation/cutting (FGM/C) by 2030. Kenya has made progress in addressing the elimination of FGM/C through ratification of global instruments and enactment of the Prohibition of FGM Act in 2011 and other supportive laws. The Act created the foundation for the establishment of the Anti-FGM Board, which provides policy leadership and coordination of anti-FGM/C programs in Kenya. More recently, the President of Kenya issued a decree for accelerated elimination of FGM/C by 2022. This synthesis report highlights how evidence generated over the last five years …
Breastfeeding: Insights For Improving Malaria, Family Planning, And Maternal And Child Health Outcomes In Northwestern Nigeria Through Social And Behavior Change Research, Breakthrough Research
Breastfeeding: Insights For Improving Malaria, Family Planning, And Maternal And Child Health Outcomes In Northwestern Nigeria Through Social And Behavior Change Research, Breakthrough Research
Reproductive Health
This brief provides evidence for implementers and researchers of social and behavior change programs designed to improve community knowledge, attitudes, norms and behaviors for pregnant and postpartum women's health. The brief focuses on key behaviors including early breastfeeding initiation within one hour of birth and exclusive breastfeeding for the first six months of life, while also discussing breastfeeding barriers and facilitators. This is one of a series of briefs that present findings from a Breakthrough RESEARCH study that captured data on a wide range of psychosocial factors of behavioral outcomes for family planning, malaria, and maternal, newborn and child health, …
Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu
Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu
Reproductive Health
Female genital mutilation/cutting (FGM/C) is a cultural practice that has health and human rights impacts on girls and women. The health sector has responsibility for prevention and response to provision of care services to women/girls with FGM/C-related complications. The mandate for the health sector response to FGM/C is anchored in nationwide or sector-specific legal/policy instruments. Kenya and Nigeria have ratified global legal/policy instruments and adopted WHO guidelines/tools for the prevention and management of FGM/C. The extent to which existing legal/policy documents in these two countries address prevention and response to management of FGM/C has been unclear. A desk review was …
Appendices—Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu
Appendices—Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu
Reproductive Health
This document contains Appendices to “Female Genital Mutilation/Cutting: A Review of Laws and Policies in Kenya and Nigeria.” Appendix 1 contains two tables: “Components of Kenyan Laws Related to FGM/C Prevention and Management,” and “Components of Nigerian Laws Related to FGM/C Prevention and Management.” Appendix 2 contains seven tables: “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Kenyan Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Nigerian Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in the Kenyan Plans of Action,” “Components Relevant to …
Quand Et Comment La Loi Est-Elle Efficace Pour Réduire La Pratique Des Mgf/E: Une Étude Transfrontalière Au Burkina Faso Et Au Mali, Josephine Wouango, Susan L. Ostermann, Daniel Mwanga
Quand Et Comment La Loi Est-Elle Efficace Pour Réduire La Pratique Des Mgf/E: Une Étude Transfrontalière Au Burkina Faso Et Au Mali, Josephine Wouango, Susan L. Ostermann, Daniel Mwanga
Reproductive Health
Les mutilations/excisions génitales féminines (MGF/E) sont reconnues mondialement pour être associées à des risques à la fois pour la santé physique et psychologique des filles et des femmes ; elle est également considérée comme une violation des droits de l'homme. À l'heure actuelle, on estime que 200 millions de filles et de femmes dans 30 pays ont subi des MGF/E et jusqu'à 30 millions de filles de moins de 15 ans sont à risque. Une réponse politique commune aux MGF/E consiste à promulguer des lois et à faire respecter les interdictions pénales. Cette note d'orientation résume les principales conclusions d'une …