Medicine and Health Sciences Commons^™

Analysis And Modeling Of Strategic Interactions In Health Systems To Improve Patient Care Access, Jorge A. Acuña Melo

USF Tampa Graduate Theses and Dissertations

Affordable health care access that provides well-coordinated and high-quality services on time is a goal that governments and health organizations strive for. Regrettably, most countries deal with access problems that affect the population's health, such as long waiting lists for specialized medical services, overcrowding of emergency departments, and high health prices. In the present doctoral dissertation, I model and analyze the strategic interactions that inhabit the health system machinery to uncover possible structural problems that led to the aforementioned issues. The study involves operation research, data science, and game theory techniques to address the health care access predicament.

Each research …

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Strengthening Capacity In Hiv Operations Research: Reflections On A Project Soar Workshop In Johannesburg, South Africa, Project Soar

HIV and AIDS

Capacity strengthening (CS) to support rigorous scientific research is a globally recognized need and central to Project SOAR. Over a four-day period, SOAR conducted a CS workshop to strengthen individual and institutional capacity in HIV operations research, with a particular emphasis on the research utilization process. This brief summarizes the CS activities conducted, insights from the workshop’s organization, and participants’ views of the workshop.

Evaluation Of The Effectiveness Of The Herhealth Model For Improving Sexual And Reproductive Health And Rights Knowledge And Access Of Female Garment Factory Workers In Bangladesh, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach

Reproductive Health

The Population Council, under its USAID-funded Evidence Project, partnered with Bangladesh’s Business for Social Responsibility program to conduct operational research to evaluate the effectiveness of the HERhealth model for improving female factory workers’ health, and to find ways to optimize program inputs and processes to support future scale-up of the intervention. This report presents findings from a pre- and post-intervention quantitative study of female factory workers from 10 factories; a qualitative study with factory managers, service providers, and implementing partners; and self-administered retention assessments of the Peer Health Educators from six factories in Dhaka, Gazipur, and Narayanganj districts. Findings from …

Providers' Views On Prep For Adolescent Girls And Young Women In Tanzania: Findings From Implementation Science Research, Population Council

HIV and AIDS

In collaboration with the Tanzania National AIDS Control Programme and CSK Research Solutions Ltd., the Population Council conducted an implementation science research study to identify key considerations among healthcare providers for oral pre-exposure prophylaxis (PrEP) introduction to adolescent girls and young women (AGYW) in an urban and a rural setting in Dar Es Salaam and Mbeya districts, respectively. This brief presents results from a survey and in-depth interviews conducted with healthcare providers in each setting, assessing their knowledge, attitudes, and perceptions about PrEP; willingness to prescribe PrEP to AGYW; and perceived barriers and facilitators to providing PrEP to AGYW. The …

Evaluation Of The Impact Of Strengthening Union Health And Family Welfare Centers For Providing 24/7 Normal Delivery Services In Bangladesh, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan, Mohammed Sharif, Forhana Rahman Noor, Surojit Kundu, Shongkour Roy, Afsana Fatema Noor, Ubaidur Rob

Reproductive Health

In Bangladesh, the majority of the infant deliveries in rural areas take place at homes where there is a higher risk of morbidity and mortality. Most Union Health and Family Welfare Centers (UHFWCs) are unable to provide 24-hour normal delivery services in close proximity to most rural women. With this point of view, the Population Council has provided technical assistance to the Directorate General of Family Planning to implement an operations research (OR) study in 24 UHFWCs to test the effectiveness of a model to strengthen UHFWCs so that they can provide such services. This report presents the findings of, …

A Model For Providing 24-Hour Normal Delivery Services At Union Health And Family Welfare Centers In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Afsana Fatema Noor

Reproductive Health

In rural areas of Bangladesh, emergency obstetric care services are available at the upazila level and above. At lower levels, Union Health and Family Welfare Centers (UHFWCs) located in the proximity of women’s homes provide normal delivery services. Recently, the Directorate General of Family Planning (DGFP) undertook an initiative to provide 24-hour normal delivery services in newly upgraded UHFWCs. The Population Council, with financial support from UKaid is providing technical assistance to the DGFP to implement an operations research study to test the effectiveness of this model. This brief presents an overview of the project, describes the implementation of project …

Project Soar's Approach To Research Utilization, Project Soar

HIV and AIDS

Project SOAR (Supporting Operational AIDS Research) conducts operations research (OR) with the aim of producing a large, multi-faceted body of high-quality evidence that can guide the planning and implementation of programs and policies for HIV prevention, care, and treatment. OR provides the needed evidence to make sound policy and program decisions at national, subnational, and service-delivery levels by identifying practical solutions to challenges delivering program services. Translating OR findings into action at these levels requires two-way information exchange between people who can apply research findings and researchers. Project SOAR’s premise is that this exchange will bring about eventual use of …

Marie Stopes International's Sifpo Project—Strengthening International Family Planning Organizations, October 2010–September 2015, Population Council

Reproductive Health

The Population Council was a partner in the Strengthening International Family Planning Organizations (SIFPO) project implemented by Marie Stopes International. SIFPO’s mandate was to increase use of voluntary family planning (FP) services globally by strengthening selected international FP organizations with global reach and an extensive, multicountry network of FP clinics for achieving maximum program impact and synergies. This report outlines the Council’s role within the project: evaluate effectiveness of MSI’s FP programs to identify successful best practices and approaches; assist MSI to disseminate the findings of some or all evaluations; strengthen MSI’s internal research and metrics capacity with thematic workshops …

Union Health And Family Welfare Centers In Chittagong And Munshiganj: Are They Ready To Provide 24-Hour Normal Delivery Services? (Brief), Population Council

Reproductive Health

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. In rural areas, public-sector health facilities, including UHFWCs, contribute to only 12 percent of institutional deliveries. Until now, Family Welfare Visitors (FWVs) posted at UHFWCs performed only 0.3 percent of deliveries. …

Creating Conditions For Scale Up: Technical Assistance As An Implementation Research Uptake Strategy, Ian Askew

Reproductive Health

No abstract provided.

Reaching The Unreached Through Community Mobilization In An Innovative And Sustainable Way, Arupendra Mozumdar, M.E. Khan, Subrato Mondal

Reproductive Health

This study shows the potential of Self Help Groups (SHGs) to deliver health messages that increase women’s knowledge. The intervention for this operations research (OR) study included a day-long training for Swasth Sakhis in the experimental area. A total of 11 trainings were organized, all conducted by Population Council staff. Before the intervention, at baseline, 803 women from eligible households were interviewed for the quantitative assessment. At endline, 470 women were followed up. Additionally, 16 in-depth interviews with women, Swasth Sakhis, and Rajiv Gandhi Mahila Vikas Pariyojana staff were conducted in the experimental area to understand how the intervention was …

Hivcore Operations Research Workshop Summary Report, Nrupa Jani

HIV and AIDS

Over the past decade, unprecedented progress has been made in the scale-up of HIV treatment, care, and support, yet substantial coverage gaps remain. Targeted operations research and program evaluation can play a significant role in ensuring efficient and effective service delivery, scaling up to reach more clients and on a broader geographical scope, enhancing quality of care, and improving the health status and health systems in developing country settings. With funding from USAID, the Population Council and partners are responding to these critical service delivery issues through HIVCore. HIVCore improves the efficiency, effectiveness, scale, and quality of HIV and AIDS …

From Problem-Solving To Research Utilization: How Operations Research And Program Evaluation Can Make Programs Better, Karen Foreit

HIV and AIDS

HIV treatment, care, and support, and PMTCT programs are most effective when based on the best available research evidence. This is the fundamental premise of evidence-based medicine. Equally well known is the dilemma of transforming evidence into practice, which is the subject of knowledge translation and implementation science. Even when the findings of clinical trials make their way into international and national program guidelines, they run up against competing priorities within public health and community programs, resource constraints, and institutional and human inertia. Understanding how to effectively change the approach used in program operations requires understanding how programs work in …

Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …

Positive Action For Hiv In Schools In Kenya, Francis Obare, Harriet Birungi, Monica Wanjiru, Sheila Bayley, John Kiunjuri, Mary Omondi, Rob Burnet, Bridget Deacon

Reproductive Health

The objective of this study was to test the feasibility of using comic books, role models, and edutainment to communicate HIV and AIDS messages to in-school young people in Kenya, with a view to improving their knowledge about the epidemic, enhancing communication about it, and promoting positive attitudes and behavior among them. The study was implemented by the Population Council in eight secondary schools in Nairobi, as part of the APHIA II Operations Research Project in collaboration with the AIDS Control Unit in the Ministry of Education, Well Told Story, and the National AIDS/STI Control Programme. The study found that …

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 …

Routine Screening For Intimate Partner Violence In Public Health Care Settings In Kenya: An Assessment Of Acceptability, Chi-Chi Undie, Catherine Maternowska, Margaret Mak'anyengo, Harriet Birungi, Jill Keesbury, Ian Askew

Reproductive Health

Most research on intimate-partner violence (IPV) screening has been conducted in developed countries, so this study in Kenya serves as one of the first in a developing-country context to assess the acceptability of IPV screening from the perspective of providers and clients in public healthcare settings. The study conducted in Kenyatta National Hospital in Nairobi found that routine screening for IPV is acceptable to providers and clients at that location. However, to be effective as a routine service, the system needs to be reinforced in specific ways, including greater assurance of confidentiality, more positive provider attitudes, and higher respect for …

Shaping The Operations Research Agenda For Antiretroviral-Based Prevention Products For Women: Gels And Rings, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes discussions from a two-day international experts consultation meeting in 2012 on preparing for the successful introduction of women-centered antiretroviral-based HIV prevention methods. It examines the limits and expectations of operations research in antiretroviral health technologies.

Integrating Alcohol Risk Reduction Into Htc Services, Population Council

Reproductive Health

This brief describes how screening for alcohol abuse and hosting long-term support groups through HIV testing and counseling centers (HTC) is one way to decrease high-risk sexual and alcohol behaviors among people who have tested for HIV. Findings from program activities funded by Population Council, Liverpool VCT and Support for Addiction Prevention and Treatment in Africa Center (SAPTA) found that screening HTC clients for alcohol abuse and referral to active support and counseling services is feasible. Follow up using SMS is also recommended. However, the lack of a control group in this study may hinder drawing direct causality between the …

Increasing Access To Family Planning (Fp) And Reproductive Health (Rh) Services Through Task-Sharing Between Community Health Workers (Chws) And Community Mid-Level Professionals In Large-Scale Public-Sector Programs: A Literature Review To Help Guide Case Studies, James R. Foreit, Sarah Raifman

Reproductive Health

This literature review covers case studies related to community-based distribution of family planning programs, and community health worker (CHW) programs that included family planning and other reproductive health services. It offers essential processes and implications for additional operations research which look at constraints and factors critical to introducing new program procedures or strengthening existing ones.

Community Health Workers Can Effectively Provide Information And Referrals To People Living With Hiv In Their Communities, Population Council

Reproductive Health

A number of studies reported high levels of sexually transmitted infections among people living with HIV (PLHIV). Unfortunately, prevention interventions targeting PLHIV in the community are not common in Kenya, and most PLHIV who are not on ART have limited access to prevention information and risk-reduction counseling. The Population Council’s APHIA II Operations Research Project conducted a research project to address these gaps. This study was conducted in 2010 in collaboration with the International Center for Reproductive Health and the National AIDS and STI Control Programme. The findings show that the intervention had a number of positive outcomes and concludes …

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

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 …

Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council

Reproductive Health

The Population Council APHIA II Operations Research Project collaborated with the Ministry of Public Health and Sanitation to improve the quality of services offered by community-based midwives in two districts in Western Kenya, to prepare them to offer more comprehensive maternal services through antenatal, obstetric, postpartum, and newborn care. The study found that community midwives can tremendously increase clients’ access to essential maternal health services and other reproductive health services. Therefore Ministry of Health and its partners should scale up community midwives’ activities to enable more women access these services. Furthermore, information campaigns are needed to promote the range of …

Community Health Workers And The Media Can Be Effective In Providing Health Information To Married Adolescent Girls In The Community, Population Council

Reproductive Health

Past research has found that married adolescent girls in Nyanza Province, Kenya, face higher risks of HIV infection than unmarried but sexually active girls their age in the province and other parts of the country. To address this challenge, the Population Council’s APHIA II Operations Research Project, in collaboration with Well Told Story and the Ministry of Public Health and Sanitation, developed a study to assess the effectiveness of an intervention designed to increase married adolescent girls’ access to comprehensive reproductive health and HIV information and services in Homa Bay and Rachuonyo districts. The study found that using interactive communication …

Ten Years Of The Kenya Adolescent Reproductive Health Project: What Has Happened?, Humphres Evelia, Monica Wanjiru, Francis Obare, Harriet Birungi

Reproductive Health

This evaluation by the Population Council’s APHIA II Operations Research Project sought to find out whether the adolescent sexual and reproductive health (ASRH) and HIV/AIDS activities in Kenya had been sustained over a 10-year period when the project was replicated and scaled up to cover seven provinces in the country. The evaluation had three main objectives: 1) to determine the extent to which activities of the Kenya Adolescent Reproductive Health Program (KARHP) have continued at national, provincial, and district levels; 2) to determine whether desired sexual and reproductive health outcomes (knowledge, behavior, and practices) have been sustained among in- and …

Using Youth-Friendly Communication Approaches To Communicate Hiv/Aids With Young People Is Feasible And Acceptable, Population Council

Reproductive Health

HIV remains a major concern in Kenya among all segments of the population, including adolescents. New ways of delivering HIV information and services are therefore needed, especially to reach young people and encourage them to take up counselling and testing to know their sero-status. The APHIA II Operations Research Project collaborated with the Ministry of Education, Well Told Story, and the National AIDS and STD Control Programme to implement a project to enhance communication in schools about HIV and create demand for early counseling and testing. The project also sought to create a supportive environment in schools for young people …

Integrating Tuberculosis Case Finding And Treatment Into Postnatal Care, Charity Ndwiga, Harriet Birungi, Chi-Chi Undie, Shiphrah Kuria, Joseph Sitienei, Sam Ochola

Reproductive Health

Under the USAID funded FRONTIERS program, the Population Council conducted a study in six health facilities in Western Kenya that demonstrated that screening for TB within an antenatal care (ANC) setting is feasible and acceptable among the service providers. However, a major challenge remains: although TB detection is encouraged among ANC clients within the maternal and child health clinics in the country, providers in these settings fail to appreciate the need for a continuum of care from pregnancy through to the postnatal period. In order to address this gap, the APHIA II Operations Research Project developed and tested an intervention …

Assessing The Potential Acceptability Of A New Cadre Of Community Midwives For Pregnancy And Delivery Related Care In Rural Pakistan: Findings From A Qualitative Study, Abdul Wajid, Ali M. Mir, Zubaida Rashid, Abida Aziz

Reproductive Health

The Population Council designed an operations research study to assess the potential acceptability of a new cadre of community midwives (CMWs) for pregnancy and delivery-related care in rural Pakistan. Specific objectives of the study were to determine the need for skilled birth attendants, identify any misconceptions in the community about CMWs, determine levels of acceptance in the community, and explore barriers to the placement of CMWs in the community. The report recommends sensitizing family members so they are more willing to grant permission for pregnant women to consult CMWs, developing flexible fee structures, giving clients greater accessibility, building a network …