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In Our Own Hands: Swaa-Ghana Champions The Female Condom, Kathleen Cravero, Michelle Skaer, Victoria Ebin, Martha Brady Jan 2006

In Our Own Hands: Swaa-Ghana Champions The Female Condom, Kathleen Cravero, Michelle Skaer, Victoria Ebin, Martha Brady

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the vital role played by the Ghana branch of the Society for Women and AIDS in Africa (SWAA) in introducing the female condom, the only female-controlled method for protection from HIV. By addressing issues of gender inequity and communication within relationships, SWAA used the female condom to empower women to regain control of their bodies. Also in this issue are profiles of three other approaches to programming for the female condom from Brazil, South Africa, and Zimbabwe.


Providing New Opportunities To Adolescent Girls In Socially Conservative Settings: The Ishraq Program In Rural Upper Egypt [Arabic], Martha Brady, Ragui Assaad, Barbara L. Ibrahim, Abeer Salem, Rania Salem, Nadia Zibani Jan 2006

Providing New Opportunities To Adolescent Girls In Socially Conservative Settings: The Ishraq Program In Rural Upper Egypt [Arabic], Martha Brady, Ragui Assaad, Barbara L. Ibrahim, Abeer Salem, Rania Salem, Nadia Zibani

Poverty, Gender, and Youth

In the absence of intervention, poor, rural, unschooled girls in conservative and low-income communities throughout West Asia and North Africa, and indeed elsewhere, are destined to a life of poverty, illiteracy, early marriage, high fertility, and poor health. This report describes Ishraq, a well-designed, multidimensional skill-building program, that has altered this scenario in Upper Egypt by intervening early (around the time of puberty). The challenge for Ishraq is to link these girls, their families, and communities to the widening opportunities and rights structures of their countries through political participation, strong partnerships, and effective links among civil society, local and national …


Spending, Saving And Borrowing: Perceptions And Experiences Of Girls In Gujarat, Shveta Kalyanwala, Jennefer Sebstad Jan 2006

Spending, Saving And Borrowing: Perceptions And Experiences Of Girls In Gujarat, Shveta Kalyanwala, Jennefer Sebstad

Poverty, Gender, and Youth

Recognizing that a better understanding of the savings patterns and potential of adolescent girls and young women is an essential prerequisite for shaping the design of appropriate savings options and services for this group, SEWA, a leading micro-credit nongovernmental organization in India, in partnership with the Population Council, conducted research among adolescent girls and young women who held accounts in one or more of SEWA’s savings schemes. The study aimed to assess their access to money, their savings and spending behaviors, their experiences as holders of savings accounts, and their preferences with regard to savings products for the young. Findings …


She Knew Only When The Garland Was Put Around Her Neck': Findings From An Exploratory Study On Early Marriage In Rajasthan, K.G. Santhya, Nicole Haberland, Ajay Kumar Singh Jan 2006

She Knew Only When The Garland Was Put Around Her Neck': Findings From An Exploratory Study On Early Marriage In Rajasthan, K.G. Santhya, Nicole Haberland, Ajay Kumar Singh

Poverty, Gender, and Youth

The Population Council undertook an exploratory, qualitative study in two districts in Rajasthan, India to understand the extent of implementation of various policies and programs intended to prevent early marriage, and the extent to which such efforts have found acceptability among parents and the community. Findings show that adolescent girls had a clear desire to marry after the age of 18 and that they were well aware of what they would have to give up with marriage—their education, childhood, health, and opportunities to explore other interests. Some parents also noted these disadvantages of early marriage, suggesting that beliefs may be …


Tap And Reposition Youth (Try): Prestar Apoio Social E Oportunidades De Microcrédito E De Poupanças A Mulheres Jovens Em Áreas Com Uma Prevalência De Vih Elevada, Annabel Erulkar, Judith Bruce, Erica Chong, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku Jan 2006

Tap And Reposition Youth (Try): Prestar Apoio Social E Oportunidades De Microcrédito E De Poupanças A Mulheres Jovens Em Áreas Com Uma Prevalência De Vih Elevada, Annabel Erulkar, Judith Bruce, Erica Chong, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku

Poverty, Gender, and Youth

Nairobi, no Quénia, acolhe uma dos maiores populações de bairros pobres na África subsariana. Os adolescentes que vivem nesses bairros, especialmente as jovens, stão privadas dos ambientes potencialmente seguros das suas escolas e famílias e não têm oportunidades económicas seguras. O desemprego é uma enorme preocupação para as jovens adolescentes e as circunstâncias desesperantes obriga-as a sobreviver conforme podem: 21% das jovens sexualmente activas entre os 15–19 anos de idade admitiram que têm relações sexuais em troca de dinheiro ou ofertas. Essa vulnerabilidade acrescida reflecte-se nas taxas da infecção pelo VIH. Em resposta a essas circunstâncias, o Population Council e …


Marriage And Childbirth As Factors In School Exit: An Analysis Of Dhs Data From Sub-Saharan Africa, Cynthia B. Lloyd, Barbara Mensch Jan 2006

Marriage And Childbirth As Factors In School Exit: An Analysis Of Dhs Data From Sub-Saharan Africa, Cynthia B. Lloyd, Barbara Mensch

Poverty, Gender, and Youth

This paper explores the potential importance of marriage and childbirth as determinants of school-leaving in sub-Saharan Africa and identifies some of the common underlying factors that contribute to premature school-leaving and early marriage and childbearing. Results suggests that the reproductive health community should see early marriage as a central area of concern for adolescent reproductive health. Policies that inform parents about the value of starting their children in school on time are likely to have beneficial effects both for grade attainment and for adolescent reproductive health regardless of school quality.


Attachment Representations In Mothers Of Young Children With Developmental Delay: Relations With Concurrent And Later Maternal Depression, Mary Catherine Hutchinson Jan 2006

Attachment Representations In Mothers Of Young Children With Developmental Delay: Relations With Concurrent And Later Maternal Depression, Mary Catherine Hutchinson

Theses and Dissertations (Comprehensive)

Despite the importance of early parent-child attachment and maternal depression to child development and the vulnerability of children with developmental delay, maternal attachment representations and their relation to depression have not been studied in this population. In this study, I examined attachment representations (i.e., internal working models) in 47 mothers of 4- to 8-year-old children with developmental delay and explored the relation between these attachment representations and maternal depression assessed concurrently and again one and two years later. The Working Model of the Child Interview (WMCI) was used to classify representations as balanced (i.e., secure) or non-balanced (i.e., disengaged or …


How To Conduct A Coverage Exercise: A Rapid Assessment Tool For Programs And Services, Carey Meyers, Solene Lardoux Jan 2006

How To Conduct A Coverage Exercise: A Rapid Assessment Tool For Programs And Services, Carey Meyers, Solene Lardoux

Poverty, Gender, and Youth

A coverage exercise (CE) is a simple, low-cost, rapid assessment tool that can be used to profile who is reached by a given service or group of service providers or organizations with a common clientele operating within a particular geographic area. This tool was developed by the Population Council to assist programs servicing youth, but it can be used for other beneficiaries as well. A CE collects data on a variety of characteristics including gender, schooling status, living arrangements, work status, and marital status of those benefiting from a program or service. It also enables program staff and managers to …


Biruh Tesfa ('Bright Future'): A Program For Poor, Urban Girls At Risk Of Exploitation And Abuse In Addis Ababa, Ethiopia, Population Council Jan 2006

Biruh Tesfa ('Bright Future'): A Program For Poor, Urban Girls At Risk Of Exploitation And Abuse In Addis Ababa, Ethiopia, Population Council

Poverty, Gender, and Youth

Low-income and slum areas in urban sub-Saharan Africa attract large numbers of rural-urban migrants in search of work and educational opportunities. Many are adolescents from poor rural areas, who risk the hazards of life in the slums in hopes of carving out a better life. These girls arrive knowing little about life in dense urban centers, often with little or no education, and no family members or friends to turn to. Many new arrivals are initially absorbed into domestic work; some eventually drift into sex work either for lack of choice or in pursuit of better pay and fewer working …


Invertir Cuando Hacerlo Cuenta: Generando La Evidencia Base Para Politicas Y Programas Para Adolescentes Muy Jóvenes—Guía Y Juego De Herramientas, Erica Chong, Kelly Hallman, Martha Brady Jan 2006

Invertir Cuando Hacerlo Cuenta: Generando La Evidencia Base Para Politicas Y Programas Para Adolescentes Muy Jóvenes—Guía Y Juego De Herramientas, Erica Chong, Kelly Hallman, Martha Brady

Poverty, Gender, and Youth

No abstract provided.


Relational Fathering: How Fathering Sons Affects Men's Relational Growth And Development: A Dissertation, Carol Watson-Philips Jan 2006

Relational Fathering: How Fathering Sons Affects Men's Relational Growth And Development: A Dissertation, Carol Watson-Philips

Educational Studies Dissertations

The purpose of this phenomenological study is to explore how fathering sons impacts men's relational growth and development. This qualitative study examines the meaning fathers make of their experience and describes their process of growth and development in connection with their sons. Twenty, mostly middle-class fathers, ages thirty-three to forty-six with sons ranging from one year to twelve years, were interviewed. Relational-Cultural Theory provides a theoretical framework. A grounded theory approach, a constructivist lens, and feminist analysis and research methods are employed. The data reveal that the fathers' connection with their sons and their perceptions of their sons' unconditional love …


Parent-Adolescent Involvement: The Relative Influence Of Parent Gender And Residence, Daniel Hawkins, Paul R. Amato, Valarie King Jan 2006

Parent-Adolescent Involvement: The Relative Influence Of Parent Gender And Residence, Daniel Hawkins, Paul R. Amato, Valarie King

Sociology and Anthropology Faculty Publications

The 1995 wave of the Add Health study is used to investigate the relative influence of parent gender and residence on patterns of parental involvement with adolescents. Adolescent reports (N = 17,330) of shared activities, shared communication, and relationship quality with both biological parents are utilized. A multidimensional scaling analysis reveals that parent gender explains most of the variance in parent-adolescent involvement, with residential status playing a secondary yet fundamental role in accounting for these patterns. Resident mothers who do not live with adolescents’ biological fathers engage in the broadest range of activities with their children. Unpartnered resident fathers display …


Family In The Church Latter-Day Saint Doctrine Regarding Family And Gender, Amber Jean Seidel Jan 2006

Family In The Church Latter-Day Saint Doctrine Regarding Family And Gender, Amber Jean Seidel

Master's Theses and Doctoral Dissertations

To discover the compatibility of traditional Christianity and mainstream feminism, a content analysis was performed on confirmed sources of doctrine of the Church of Jesus Christ of Latter-day Saints. Through systematic reading and identifying themes of God and the Bible, gender role separation, patriarchy, or domestic violence, an analysis of pertinent feminist criticisms was performed. Latter-day Saint doctrine of family includes the following statements: (1) there is a Heavenly Mother as a divine partner to Heavenly Father, (2) the Bible contains errors regarding respect toward women, (3) women need to be active in education, home, and community, (4) men should …


Mom's The Word: The Portrayal Of The Single Mother/Son Relationship In Children's Literature, Sheryl Renee Haveman Jan 2006

Mom's The Word: The Portrayal Of The Single Mother/Son Relationship In Children's Literature, Sheryl Renee Haveman

Graduate Research Papers

Our culture is abounding with boys being raised solely by their mother. Awareness of the impact of divorce and the importance of a male role model for a young boy has increased and is represented in literature. Authors of children's literature have been continuing the tradition of dealing openly and honestly with many society issues. Despite the large number of books that include single mothers and their sons, the researcher questioned whether or not children's picture and chapter books were accurately portraying the dynamics involved with the single mother/son relationship.

The purpose of this study was to examine children's literature …


Multiple Disadvantages Of Mayan Females: The Effects Of Gender, Ethnicity, Poverty, And Residence On Education In Guatemala, Kelly Hallman, Sara Peracca, Jennifer Catino, Marta Julia Ruiz Jan 2006

Multiple Disadvantages Of Mayan Females: The Effects Of Gender, Ethnicity, Poverty, And Residence On Education In Guatemala, Kelly Hallman, Sara Peracca, Jennifer Catino, Marta Julia Ruiz

Poverty, Gender, and Youth

Although access to primary education in Guatemala has increased in recent years, particularly in rural areas, levels of educational attainment and literacy remain among the lowest in Latin America. Inequalities in school access and grade attainment linked to ethnicity, gender, poverty, and residence remain. Age trends show that Mayan females are the least likely to ever enroll, and, if they do enroll, start school the latest and drop out earliest. Innovative programs for girls that combine instruction with social interaction in safe local community spaces may increase their educational attainment and their social networks and means of social support. In …


Living Up To Their Name: Profamilia Takes On Gender-Based Violence, Claudia Garcia-Moreno, Rachel E. Goldberg Jan 2006

Living Up To Their Name: Profamilia Takes On Gender-Based Violence, Claudia Garcia-Moreno, Rachel E. Goldberg

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the evolution of Profamilia through its work on gender-based violence in the Domincan Republic.Their project was conceived along two simultaneous paths: providing support services directly to women and girls who had experienced violence and initiating advocacy in the wider policy arena. Profamilia joined the commission that ultimately designed and promoted a law to increase protection against violence, especially domestic violence against women and children. Although the clinics now run a dynamic service program, the agency has also sustained its advocacy activities. Most of Profamilia’s advocacy work is undertaken in partnership with other NGOs or with …


Slow Fertility Transition In Egypt: Reaching Policy-Makers And Program Managers With The Findings, Nahla G. Abdel-Tawab, Rania Roushdy, John B. Casterline Jan 2006

Slow Fertility Transition In Egypt: Reaching Policy-Makers And Program Managers With The Findings, Nahla G. Abdel-Tawab, Rania Roushdy, John B. Casterline

Poverty, Gender, and Youth

Following a period of relatively rapid decline in the 1980s and early 1990s, the Egyptian fertility decline slowed down during the later part of the 1990s. The main objective of the Slow Fertility Transition (SFT) project was to better understand the current slow pace of fertility decline in Egypt and to identify policies that can facilitate decline to replacement level. This project investigated attitudes toward childbearing and, in particular, receptivity to the two-child family. The SFT project re-interviewed a subsample of 3,286 currently married women who had been interviewed in the 2003 EIDHS. Two further samples were also interviewed in …


Facts About Adolescents From The Demographic And Health Survey—Statistical Tables For Program Planning: Malawi 2000, Population Council Jan 2006

Facts About Adolescents From The Demographic And Health Survey—Statistical Tables For Program Planning: Malawi 2000, Population Council

Poverty, Gender, and Youth

The Population Council initiated its work on adolescents in the mid-1990s. At that time, those advocating greater attention to adolescent issues were concerned about adolescent fertility—particularly outside of marriage—and adolescent “risk-taking” behavior. As an international scientific organization with its mandate centered around the needs of developing countries, the Council sought a more nuanced and context-specific understanding of the problems confronting adolescents in the developing world. In working with colleagues inside and outside the Council, it became clear that information on adolescents, and the way data are organized, were limiting the ability to understand the diversity of their experiences or to …


Integrating Adolescent Livelihood Activities Within A Reproductive Health Programme For Urban Slum Dwellers In India, Population Council Jan 2006

Integrating Adolescent Livelihood Activities Within A Reproductive Health Programme For Urban Slum Dwellers In India, Population Council

Poverty, Gender, and Youth

Although a wide variety of livelihood programs for adult women exist in India, they rarely include adolescent girls. Of those that do, few employ rigorous scientific methods to evaluate program impact. This brief describes a project conducted in slum areas of Allahabad, in Uttar Pradesh. The Population Council, in collaboration with CARE-India, tested the feasibility and impact of adding four livelihoods and life-skill components to a reproductive health program for adolescent girls (both school-going and out-of-school) aged 14–19. Using a quasi-experimental pre- and post-test design that contrasted the experimental group with a comparison group of adolescents, the project investigated whether …


Formation Of Partnerships Among Young Women And Men In Pune District, Maharashtra, Population Council Jan 2006

Formation Of Partnerships Among Young Women And Men In Pune District, Maharashtra, Population Council

Poverty, Gender, and Youth

Aside from their educational attainment, economic activity levels, and age at marriage, little is known about the lives of young people in India, especially the extent to which and the contexts in which they form romantic, marital, and other partnerships or the nature of these partnerships. At a time when India's youth policy and reproductive and child health programs have acknowledged the need to focus on youth, it is central that these gaps in understanding are filled. The KEM Hospital Research Centre and the Population Council conducted a study in Maharashtra in 2003–05 to obtain information on romantic and sexual …


Youth In India: Situation And Needs Study, Population Council Jan 2006

Youth In India: Situation And Needs Study, Population Council

Poverty, Gender, and Youth

Youth aged 15–24 represent 20 percent of the Indian population. This cohort faces significant risks related to sexual and reproductive health (SRH), and many lack the knowledge and power to make informed SRH choices. Information on intimate partnerships among youth, female and male, married and unmarried, is sparse and evidence is practically nonexistent that identifies the factors that protect young people's ability to ensure safe SRH and their autonomy to make informed decisions. This brief describes a subnational study of young people's situation and needs that aims to fill these gaps. Six states were selected for study, representing different geographical …


Tap And Reposition Youth (Try) Program: Providing Social Support, Savings, And Microcredit Opportunities To Adolescent Girls At Risk For Hiv/Aids In Kenya, Joan Hall, Aleke Dondo, Jennefer Sebstad Jan 2006

Tap And Reposition Youth (Try) Program: Providing Social Support, Savings, And Microcredit Opportunities To Adolescent Girls At Risk For Hiv/Aids In Kenya, Joan Hall, Aleke Dondo, Jennefer Sebstad

Poverty, Gender, and Youth

This brief was commissioned by the Population Council to complement its two previous publications on the TRY project. The two previous publications contain data and information essential for understanding the project and its results, although they do not analyze the microfinance component in depth. In contrast, this brief was written by microfinance practitioners for a microfinance audience. In 1998, the Population Council and K-Rep (a Kenyan microfinance institution) developed a microfinance approach to address livelihood-strategy constraints for adolescent girls at risk for HIV/AIDS in an urban slum in Kenya. The initiative was named the Tap and Reposition Youth (TRY) program, …


Measuring Women's Work: A Methodological Exploration, Ray Langsten, Rania Salem Jan 2006

Measuring Women's Work: A Methodological Exploration, Ray Langsten, Rania Salem

Poverty, Gender, and Youth

In this working paper, the authors contrast two approaches to the measurement of women’s work applied to the same population of ever-married women. These women were interviewed on two occasions—first during the 2003 Interim Egypt DHS, and again during the Slow Fertility Transition (SFT) survey conducted in 2004. The DHS uses a standard keyword question to measure work, while the SFT employs an activities list question format. The authors argue that the widely used keyword approaches to measuring women’s work underestimate the level of female labor force activity. They demonstrate that the activities list approach captures a wider range of …


Earthquake Vulnerability Assessment Pakistan, 2005–06, Arshad Mahmood Jan 2006

Earthquake Vulnerability Assessment Pakistan, 2005–06, Arshad Mahmood

Poverty, Gender, and Youth

The 7.6-magnitude earthquake on October 8, 2005, caused a large number of deaths, and left more than 100,000 people injured and an estimated 3 million people displaced or homeless. To assist the Government of Pakistan in the preparation of a rehabilitation plan, the first step was to identify the vulnerable people living in the tent camps. The Population Council completed an assessment survey of the camps in the earthquake area. This assessment is distinctive from the surveys carried out previously, since it collects socio-demographic and vulnerability indicators about each individual. The assessment is useful in tracking the conditions of especially …


Investing When It Counts: Generating The Evidence Base For Policies And Programmes For Very Young Adolescents—Guide And Tool Kit, Erica Chong, Kelly Hallman, Martha Brady Jan 2006

Investing When It Counts: Generating The Evidence Base For Policies And Programmes For Very Young Adolescents—Guide And Tool Kit, Erica Chong, Kelly Hallman, Martha Brady

Poverty, Gender, and Youth

No abstract provided.


Tap And Reposition Youth (Try): Providing Social Support, Savings, And Microcredit Opportunities For Young Women In Areas With High Hiv Prevalence, Annabel Erulkar, Judith Bruce, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku Jan 2006

Tap And Reposition Youth (Try): Providing Social Support, Savings, And Microcredit Opportunities For Young Women In Areas With High Hiv Prevalence, Annabel Erulkar, Judith Bruce, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku

Poverty, Gender, and Youth

Tap and Reposition Youth (TRY) was a multiphase initiative undertaken by the Population Council and K-Rep Development Agency (KDA), the oldest and largest microfinance institution in Kenya. The overall aim of the project was to reduce adolescents’ vulnerabilities to adverse social and reproductive health outcomes, including HIV infection, by improving their livelihoods options. The project was launched in low-income and slum areas of Nairobi, Kenya, where rates of HIV infection are alarming and where young women are disproportionately affected.


Tap And Reposition Youth (Try): Providing Social Support, Savings, And Microcredit Opportunities For Young Women In Areas With High Hiv Prevalence, Annabel Erulkar, Judith Bruce, Erica Chong, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku Jan 2006

Tap And Reposition Youth (Try): Providing Social Support, Savings, And Microcredit Opportunities For Young Women In Areas With High Hiv Prevalence, Annabel Erulkar, Judith Bruce, Erica Chong, Aleke Dondo, Jennefer Sebstad, James K. Matheka, Arjmand Banu Khan, Anne Gathuku

Poverty, Gender, and Youth

Nairobi, Kenya is home to one of the largest slum populations in sub-Saharan Africa. Adolescents living in these slums, especially girls, are cut off from the potentially protective environments of school and family and lack safe economic opportunities. Unemployment is a major concern for adolescent girls, and desperate circumstances force them to survive however they can: 21 percent of sexually active girls aged 15–19 report exchanging sex for money or gifts. This heightened vulnerability is reflected in rates of HIV infection. In response to these circumstances, the Population Council and microfinance institution K-Rep Development Agency collaborated on the implementation of …


Influencing Girls' Lives: Acceptability And Effectiveness Of A Livelihoods Skill Building Intervention In Gujarat, Sewa, Sewa Academy, Shveta Kalyanwala, Rajib Acharya, Sunetra Deshpande Jan 2006

Influencing Girls' Lives: Acceptability And Effectiveness Of A Livelihoods Skill Building Intervention In Gujarat, Sewa, Sewa Academy, Shveta Kalyanwala, Rajib Acharya, Sunetra Deshpande

Poverty, Gender, and Youth

The Self Employed Women’s Association (SEWA), a key Indian micro-finance nongovernmental organization, in partnership with the Population Council, undertook a pilot livelihoods skill-building program to support adolescent girls aged 13–19 years (mostly unmarried, in school and out of school). Like other such programs, this livelihoods program focused on exposing girls to new ideas, building social networks, exposing them to the world around them, and providing the technical skills needed to enhance their access to income generating opportunities. The study’s findings are mixed, but suggest that a life and livelihoods skill-building intervention program for girls is acceptable to adolescents (and their …


Poverty, Wealth Inequality, And Health Among Older Adults In Rural Cambodia, Zachary Zimmer Jan 2006

Poverty, Wealth Inequality, And Health Among Older Adults In Rural Cambodia, Zachary Zimmer

Poverty, Gender, and Youth

This working paper examines the distribution of household wealth and tests whether associations exist between wealth inequality and health outcomes among older adults living in one of the world’s poorest regions, rural Cambodia. Results confirm difficult economic conditions among most elderly in rural Cambodia. This study suggests there is some validity to generalizing the relationship between wealth inequality and health to extremely poor populations and that a very small difference in wealth makes a relatively large difference in regard to the association with health among those living in impoverished surroundings.


Assessment Of District Health Supervisory System, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Assessment Of District Health Supervisory System, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project designed to reduce the country's maternal and neonatal mortality by making sure women have access to skilled birth attendants during childbirth and throughout the postpartum period. PAIMAN developed a community-based approach that provides a continuum of care to mothers and newborns through supportive linkages from home care to hospital-based care. Various assessments of the district health system suggest that it suffers from weaknesses that impair its efficiency, quality, and impact. Inefficient and ineffective supervision is one of the most important factors for the health sector’s poor performance. Effective, …