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Full-Text Articles in Health Policy

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows Jan 2018

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …


Adolescent Health: Priorities And Opportunities For Rashtriya Kishor Swasthya Karyakram (Rksk) In Uttar Pradesh, Sapna Desai Jan 2017

Adolescent Health: Priorities And Opportunities For Rashtriya Kishor Swasthya Karyakram (Rksk) In Uttar Pradesh, Sapna Desai

Poverty, Gender, and Youth

The Government of India in 2014 signaled its commitment to adolescent health through introduction of a national strategy, Rashtriya Kishor Swasthya Karyakram (RKSK). Targeting adolescents aged 10–14 and 15–19, the program aims to ensure universal coverage of health information and services for all adolescents—those in and out of school, married or unmarried, and in vulnerable groups. Envisaged as a paradigm shift to address adolescent health beyond sexual and reproductive health, RKSK spans six domains: nutrition, sexual and reproductive health, mental health, injuries and violence including gender-based violence, substance misuse, and non-communicable diseases. This policy brief presents evidence on adolescent health …


Routine Screening For Intimate Partner Violence: A Guide For Trainers, Odongo Odiyo, Chi-Chi Undie, Margaret Mak'anyengo Jan 2016

Routine Screening For Intimate Partner Violence: A Guide For Trainers, Odongo Odiyo, Chi-Chi Undie, Margaret Mak'anyengo

Reproductive Health

This the first regional document devoted to building the capacity of providers to respond to intimate partner violence (IPV). The training guide is a follow-on initiative to the 6th Best Practices Forum in Health of the East, Central and Southern Africa (ECSA) Health Community, held in August 2012. This Forum brought to the fore research findings from the region centering on the acceptability and feasibility of IPV screening, and culminated in the passage of a resolution by Health Ministers that prescribes the integration of gender-based violence screening into healthcare settings in the ECSA region. This training guide responds to this …


The Consumer Perspective: A Consultation With Senior Health Officials From Developing Countries On Standards Of Evidence For Reproductive And Maternal Health Care, The Evidence Project, Step Up Research Programme Consortium Jan 2016

The Consumer Perspective: A Consultation With Senior Health Officials From Developing Countries On Standards Of Evidence For Reproductive And Maternal Health Care, The Evidence Project, Step Up Research Programme Consortium

Reproductive Health

The Population Council (through the STEP UP consortium and the Evidence Project) and the High Impact Practices (HIP) Collaboration, together with other partners, held a series of three consultative meetings around the topic of standards of evidence in reproductive and maternal health. This report details the third and final meeting held in Bellagio, Italy in February 2016. The meeting brought together developing-country decisionmakers to vet, from the research “consumer” perspective, the recommendations that emerged from the second consultation and to elicit further recommendations on how to better generate and package evidence to meet the needs of decisionmakers. Also in attendance …


Kenya Adolescent Sexual And Reproductive Health Policy, Ministry Of Health Kenya Jan 2015

Kenya Adolescent Sexual And Reproductive Health Policy, Ministry Of Health Kenya

Reproductive Health

This document is a review and revision of the National Adolescent Sexual and Reproductive Health Policy of Kenya, which involved in-depth consultations with a wide range of stakeholders through literature review, interviews, consultative meetings, and reviews of the various drafts. Many changes took place at the national and international levels that needed to be taken into account as the policy was reviewed, including the Constitution of Kenya (2010) with its attendant devolved governance structure as well as demographics, and social, economic, and technological environment. The government has made concerted efforts as part of Vision 2030 to respond to adolescents and …


Education Sector Response To Early And Unintended Pregnancy: A Policy Dialogue In Homa Bay County, Kenya, Chi-Chi Undie, Ian Mackenzie, Harriet Birungi, Stephen Barongo, Diosiana Ahindukha, Caleb Omondi Jan 2015

Education Sector Response To Early And Unintended Pregnancy: A Policy Dialogue In Homa Bay County, Kenya, Chi-Chi Undie, Ian Mackenzie, Harriet Birungi, Stephen Barongo, Diosiana Ahindukha, Caleb Omondi

Reproductive Health

In collaboration with the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) Research Programme Consortium, the Population Council implemented a project to increase the demand for secondary school education in Homa Bay County, Kenya—an area characterized by high, unintended teenage pregnancy and female school drop-out rates. To foster awareness of the school re-entry policy, the Population Council collaborated with the Homa Bay County Department of Education (Ministry of Education) to convene a policy dialogue for all principals of public, day, girls-only, and co-educational secondary schools in the area. The policy dialogue helped to create visibility around the issue of …


Expanding Access To Education For Teenage Mothers In Homa Bay County: What ‘Might’ Work, Chi-Chi Undie Jan 2015

Expanding Access To Education For Teenage Mothers In Homa Bay County: What ‘Might’ Work, Chi-Chi Undie

Reproductive Health

No abstract provided.


Expanding Access To Secondary School Education For Teenage Mothers In Kenya: A Baseline Study Report, Chi-Chi Undie, Harriet Birungi, George Odwe, Francis Obare Jan 2015

Expanding Access To Secondary School Education For Teenage Mothers In Kenya: A Baseline Study Report, Chi-Chi Undie, Harriet Birungi, George Odwe, Francis Obare

Reproductive Health

Carried out in Homa Bay County, Kenya, this study provides a baseline assessment involving the following data collection components: a household survey with out-of-school teenage girls (regardless of whether they had ever been pregnant or not), teenage mothers, and their household heads; and a school survey with secondary school principals and students. The objectives of the study were to: 1) foster an understanding of the current situation and context in regard to out-of-school teenage mothers and their potential support systems for school re-entry at the household and school levels; 2) clarify possible solutions for promoting school re-entry on the part …


Strengthening School Health Programming In Nairobi City County, Joyce Mumah Jan 2015

Strengthening School Health Programming In Nairobi City County, Joyce Mumah

Reproductive Health

No abstract provided.


Unintended Pregnancy By The Numbers: A Look At Kenya, Carol Mukiira, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara Jan 2014

Unintended Pregnancy By The Numbers: A Look At Kenya, Carol Mukiira, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara

Reproductive Health

This fact sheet summarizes data collated during the development of the STEP UP Country Profile Report on Unintended Pregnancies for Kenya, which presents a range of key evidence aimed at informing readers about the trends, magnitude, determinants, and consequences of unintended pregnancy in Kenya. The data shown in this fact sheet are drawn mainly from the 1993, 1998, 2003 and 2008/09 Kenya Demographic and Health Surveys (KDHS) as well as other secondary sources.


Increasing Access To Family Planning In Ghana Through Policy Change: Task-Sharing To Enable Auxiliary Nurses To Provide Contraceptive Implant Services, Population Council Jan 2014

Increasing Access To Family Planning In Ghana Through Policy Change: Task-Sharing To Enable Auxiliary Nurses To Provide Contraceptive Implant Services, Population Council

Reproductive Health

Ghana has made significant progress toward reducing the maternal mortality ratio but the rate is still unacceptably high. Up to 26 percent of married Ghanaian women have unmet need for family planning and one in four currently married women is using a modern contraceptive method. Satisfying unmet need for family planning could cut the number of maternal deaths by almost a third. One factor contributing to low usage of modern methods is shortage of trained staff, particularly those skilled in providing long-acting reversible and permanent methods. Until recently, implant services were provided primarily by Ghana Health Service (GHS) trained midwives, …


Kalkidan ('Promise'): Addressing Marital Transmission Of Hiv In Ethiopia, Banchiamlack Dessalegn, Annabel Erulkar Jan 2013

Kalkidan ('Promise'): Addressing Marital Transmission Of Hiv In Ethiopia, Banchiamlack Dessalegn, Annabel Erulkar

Poverty, Gender, and Youth

This program brief describes a Population Council initiative in three low-income areas of Ethiopia. Kalkidan (Amharic for “Promise”) is a three-year program designed to increase discussion and information-sharing on HIV and related topics between marital partners; to promote HIV prevention and health service utilization within marriage, including prevention of mother-to-child transmission (PMTCT) of HIV; and to build husbands’ support of their wives, as well as investment in their health and that of their children. Kalkidan recruits and trains community-based mentors to lead parallel discussion groups of husbands and wives, who periodically come together for joint sessions. The Population Council is …


Scaling Up Advocacy For Gender-Based Violence And Child Sexual Abuse In The East, Central And Southern Africa Region: Technical Exchange And Meeting, East Central And Southern African Health Community Jan 2013

Scaling Up Advocacy For Gender-Based Violence And Child Sexual Abuse In The East, Central And Southern Africa Region: Technical Exchange And Meeting, East Central And Southern African Health Community

Reproductive Health

The East, Central and Southern Africa (ECSA) Health Community, which prioritizes gender-based violence and child sexual abuse as regional health concerns, partnered with the Population Council to convene a pre-conference Expert Committee meeting of the Research, Information and Advocacy Programme. The conference marked a major milestone in the ECSA Health Community’s commitment to promote and support region-wide sharing and utilization of health research and policy information among its member states. This report summarizes the deliberations of the two-day workshop and the recommendations for implementing an advocacy plan to address this important facet of the region’s development agenda.


Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey Jan 2012

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …


Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan Jan 2012

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …


The Africa Regional Sexual And Gender-Based Violence Network Annual Partners Meeting: June 26-27 2012, Mombasa, Kenya—Meeting Report, Population Council Jan 2012

The Africa Regional Sexual And Gender-Based Violence Network Annual Partners Meeting: June 26-27 2012, Mombasa, Kenya—Meeting Report, Population Council

Reproductive Health

The Population Council convened an annual partners meeting of its Africa Regional Sexual and Gender-Based Violence (SGBV) Network. Over 30 participants attended the meeting whose objectives were: 1) to facilitate South-South technical exchange and information-sharing on the changing landscape of violence among partners, donors, and other experts; and 2) to reflect on the ways in which research is translating into policy and practice. This report highlights the myriad ways in which activities conducted under this Network have influenced policy, practice, and funding considerations in the region, while detailing the progress of Network partners on their projects, built around several key …


Community Midwifery Services In Kenya: Implementation Guidelines, Kenya Ministry Of Health Jan 2012

Community Midwifery Services In Kenya: Implementation Guidelines, Kenya Ministry Of Health

Reproductive Health

Community midwifery guidelines by the Kenya Minister for Health have been revised in order to standardize the implementation of community midwifery services as a strategy for improving skilled attendance in the provision of maternal and newborn health care at the community level. The revised guidelines address key policies that are outlined in the Kenya Health Policy regarding the provision of essential packages for health in line with the new constitution, Vision 2030, and the Community Health Strategy. The policy emphasizes a shift of focus to preventive and promotive health care; major strategies include improving access, realizing equity goals, and providing …


The Impact Of Water Supply And Sanitation On Child Health: Evidence From Egypt, Rania Roushdy, Maia Sieverding, Hanan Radwan Jan 2012

The Impact Of Water Supply And Sanitation On Child Health: Evidence From Egypt, Rania Roushdy, Maia Sieverding, Hanan Radwan

Poverty, Gender, and Youth

Using a combination of qualitative and quantitative data, this working paper investigates whether access to improved sources of water and sanitation is an effective “treatment” for the incidence of diarrhea among children under five years of age in Egypt. Both components of the study indicate that widespread access to improved sources of drinking water and toilet facilities exists across Egypt; however, service quality remains a significant problem in many areas. In particular, cuts in water supply—and the resulting practice of storing water—are quite common; a sizable percentage of flush toilet facilities are not connected to the public sewer system; and …


First Generation Of Gender And Hiv Programs: Seeking Clarity And Synergy, Judith Bruce, Nicole Haberland, Amy Joyce, Eva Roca, Tobey Nelson Sapiano Jan 2011

First Generation Of Gender And Hiv Programs: Seeking Clarity And Synergy, Judith Bruce, Nicole Haberland, Amy Joyce, Eva Roca, Tobey Nelson Sapiano

Poverty, Gender, and Youth

In the past decade, there have been expanding resources to address the underlying gender dimensions of HIV. This has been particularly urgent in sub-Saharan Africa as the female-to-male infection ratios in young populations has reached 3 to 1 and sometimes above. The phrase “gender and HIV” has become commonplace yet does not provide any specific guidance as to target audiences, content, or measurable results. It can include everything from microcredit programs for HIV-positive women, to workplace programs seeking to change negative male norms, to efforts to increase respect for diverse sexual and gender identities. This review, conducted by the Population …


National Efforts Toward Fgm-Free Villages In Egypt: The Evidence Of Impact, Ghada Barsoum, Nadia Rifaat, Omaima El-Gibaly, Nihal Elwan, Natalie Forcier Jan 2011

National Efforts Toward Fgm-Free Villages In Egypt: The Evidence Of Impact, Ghada Barsoum, Nadia Rifaat, Omaima El-Gibaly, Nihal Elwan, Natalie Forcier

Poverty, Gender, and Youth

This report is a midterm evaluation and documentation of the process and approach of the FGM-Free Village Model implemented in Egypt by the National Council of Childhood and Motherhood with assistance from the Population Council. In a comparison of responses from women and men in intervention groups to those in nonintervention (control) villages, data analysis shows that the program has been successful in changing views and attitudes toward female genital mutilation (FGM). FGM is an entrenched generational practice, and eradicating it in a community requires concerted effort over an extended period of time. This evaluation strongly recommends that efforts be …


Scaling Up The Provision Of Family Planning Messages In Antenatal And Postpartum Services In Upper Egypt, Nahla G. Abdel-Tawab, Sally Saher Jan 2011

Scaling Up The Provision Of Family Planning Messages In Antenatal And Postpartum Services In Upper Egypt, Nahla G. Abdel-Tawab, Sally Saher

Reproductive Health

An operations research study by the Population Council’s FRONTIERS program in 20 facilities in Upper Egypt showed that integration of birth spacing messages into antenatal and postpartum care was feasible, acceptable to women and their husbands, and was associated with increased postpartum contraception. This report describes the initial and scale-up phases, their outcomes, challenges, and recommendations for improvement. In addition to successfully scaling up the program, the main achievement was securing the support and investment of senior MoHP officials at the central level, as well as the support and commitment of managers and supervisors at governorate and district levels. The …


A Pay-For-Performance Innovation Integrating The Quantity And Quality Of Care In Maternal, Newborn And Child Health Services In Bangladesh, Laila Rahman, Ubaidur Rob, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Md. Noorunnabi Talukder, Md. Hafizur Rahman Jan 2011

A Pay-For-Performance Innovation Integrating The Quantity And Quality Of Care In Maternal, Newborn And Child Health Services In Bangladesh, Laila Rahman, Ubaidur Rob, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Md. Noorunnabi Talukder, Md. Hafizur Rahman

Reproductive Health

The Population Council explored the possibilities of introducing a Pay-for-Performance (P4P) scheme in Bangladesh to improve maternal, newborn and child healthcare (MNCH) services. Based on the consultation and with guidance from the Government of Bangladesh, the Population Council and UNICEF provided technical assistance to the Directorate General of Health Services (DGHS) to test two P4P strategies for MNCH service providers to improve service volume and quality of care, and for poor clients to receive services subsidized through vouchers or coupons. The first strategy is a combination of pay-for-performance for providers and subsidized coupons for poor pregnant women, newborns, and under-five …


Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena Jan 2011

Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena

Reproductive Health

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to …


Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council Jan 2011

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …


Making Hiv Services More Responsive To Young Children And Infants In Nyanza, Monica Wanjiru Jan 2011

Making Hiv Services More Responsive To Young Children And Infants In Nyanza, Monica Wanjiru

Reproductive Health

Health workers in Kenya often miss opportunities to discuss pediatric HIV with clients and to track exposed children in order to initiate treatment. To address this problem, the Population Council’s APHIA II Operations Research Project collaborated with the Christian Health Association of Kenya, Catholic Relief Services, and the Kendu Adventist Hospital to improve HIV testing and treatment services for children at the hospital. The project recommended that pediatric HIV services be strengthened and included as an essential service at all levels of healthcare facilities in order to reach more children, including as one of the roles of the community health …


Service Improvements And Community Education Lead To Increase In Uptake Of Hiv Services For Infants And Young Children, Population Council Jan 2011

Service Improvements And Community Education Lead To Increase In Uptake Of Hiv Services For Infants And Young Children, Population Council

Reproductive Health

The Population Council’s APHIA II Operations Research Project in Kenya collaborated with Kendu Adventist Hospital and the Christian Health Association to launch a study to examine the effect of improved services and awareness-creation on the uptake of HIV testing and treatment services for children and infants exposed to HIV. The study showed that community education and improvements in individual case tracking can increase the proportion of infants exposed to HIV who are tested for HIV and put on appropriate treatment. The policy brief recommends that health facilities streamline services to ensure that as many exposed infants as possible are identified …


Increasing Institutional Delivery And Access To Emergency Obstetric Care Services In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council Jan 2010

Increasing Institutional Delivery And Access To Emergency Obstetric Care Services In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative in rural Uttar Pradesh (UP), India to determine the impact of the Janani Suraksha Yojana (JSY) scheme on the current status of institutional delivery in the region, to understand the facilitating factors and barriers in delivering in a health facility, and to identify programmatic and behavior change communication (BCC) initiatives that could accelerate the adoption of institutional delivery. JSY was launched as an intervention to address the barriers to institutional delivery, through the introduction of community-based women volunteers. The study shows that with the introduction of the JSY the rate of institutional delivery jumped …


Proceedings And Presentations From The Free State Child Abuse Indaba, Population Council Jan 2010

Proceedings And Presentations From The Free State Child Abuse Indaba, Population Council

Reproductive Health

The Free State Department of Health and its partners held a “first-of-its kind” Child Sexual Assault Indaba (conference) in South Africa to streamline relationships between services for effective prevention and management of child abuse. This report details the presentations delivered at the conference, which was a resounding success, with participation from a wide range of stakeholders. The recurring theme of all the presentations was the urgent need to unite and fight against child sexual assault. The most appropriate strategy was unanimous—information—and clarity in terms of the role of each stakeholder. The Free State Department of Health will coordinate the development …


Training Service Providers Increases Tb Screening In Postnatal Care, Population Council Jan 2010

Training Service Providers Increases Tb Screening In Postnatal Care, Population Council

Reproductive Health

This document summarizes a Population Council operations research project undertaken in collaboration with the Kenya Ministry of Health to develop and pilot-test an intervention to improve TB screening, case detection, treatment, and care among postnatal clients. The intervention demonstrated that it is feasible to use postnatal care services as a platform to increase TB screening and case detection. Training providers, giving them job-aids, and strengthening client flow within the facility also improved the overall quality of care that the clients received. The actual number of cases of TB detected was extremely low, however; thus the report recommends that the Ministry …


Guidelines For Pilot Study On Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Directorate General Of Health Services (Dghs), Population Council, Unicef Jan 2010

Guidelines For Pilot Study On Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Directorate General Of Health Services (Dghs), Population Council, Unicef

Reproductive Health

The Population Council launched a pilot study to test two Pay-for-Performance (P4P) strategies to improve MNCH services in Bangladesh. This document presents guidelines for offering incentives to providers, distributing coupons, and forming P4P and/or Coupon Committees and Quality Assurance Groups. The guidelines were developed over the course of five policy-level and consensus-building workshops with national and local-level program managers and service providers, organized under the leadership of the DGHS, in consideration of the local context and sustainability in case of nationwide replication in the country. These guidelines will come into effect upon receiving approval from the DGHS, Ministry of Health …