Public Health Commons^™

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 …

Public Expenditure On Health Care In Orissa: Focus On Reproductive And Child Health Services, Sarit Kumar Rout

Reproductive Health

In view of the importance of public financing in influencing health outcomes and the paucity of studies that have explored patterns of resource allocation on reproductive and child health services, a study was undertaken in Orissa, India to examine the pattern of and trends in public expenditure on health care with a special focus on expenditure on reproductive and child health services. The study was part of the Population Council, India’s Health and Population Innovation Fellowship program. Findings indicate that major policy issues such as the transfer of power to panchayati raj institutions and those involving health administration and management, …

Increasing Appropriate Complementary Feeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine current complementary feeding practices among children aged 6–23 months; understand the facilitating factors and barriers in adopting appropriate complementary feeding practices; and identify programmatic and behavior change communication (BCC) initiatives that could promote the adoption of appropriate complementary feeding practices. The qualitative study shows that women and family members did not feed a measured quantity of food to their children. A lack of knowledge and lack of communication created barriers to initiating complementary feeding. The policy brief recognized education and antenatal care as facilitating factors and …

Increasing Early And Exclusive Breastfeeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine the current status of early and exclusive breastfeeding, understand the facilitating factors and barriers in adopting the desired breastfeeding practices, and identify programmatic and behavior change communication (BCC) initiatives to promote the practice. Findings indicate that efforts by Primary Health Centre staff to counsel and encourage women to breastfeed early could significantly increase adoption of this practice. The policy brief identifies barriers that reflect a lack of knowledge and misperceptions about breastfeeding, but finds that education, supportive family members, and knowledgeable health workers can facilitate breastfeeding. …

Reach Of Media And Interpersonal Communication In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

RK Swamy BBDO and the Population Council carried out an analysis to assess the reach of the media and interpersonal communication (IPC). The advertising agency and partner in a Population Council–led consortium analyzed data to explore the reach of various mass media and viewership patterns. The Population Council analyzed the reach of other sources of information, including mobile phones, mid-media, IPC, and mass media (print media, radio, and TV). This policy brief discusses describes the current status and trends in mass media exposure and media reach by audience segmentation. It also explores the reach of mid-media and IPC between frontline …

Media Perspectives On Partnerships To Address Family Health In Northern India: Implications For Behavior Change Communication, Population Council

Reproductive Health

Ideosync Media Combine, a partner in the Population Council-led consortium, conducted a qualitative study of media agencies to explore the perspectives of senior media managers in northern India on the following issues: (a) the decisionmaking process related to content; (b) the approaches adopted for audience targeting and feedback; (c) the extent of health-related coverage in the media and the process of prioritization of other development issues; and (d) partnership priorities and possibilities for collaboration. The policy brief discusses findings related to these issues and presents implications for the behavior change communication strategy.

Role Of The Corporate Sector In Promoting Family Health In Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Confederation of Indian Industry, a partner in the Population Council–led Consortium, took the lead to explore a) the role of the corporate sector in family health in Uttar Pradesh, India; b) the possibility of partnering with this sector to design, leverage, and implement a behavior change communication (BCC) strategy; and c) the support and assistance the sector would require to ensure better planning and implementation of their corporate social responsibility (CSR) activities. Based on the findings, this policy brief identified the following, with implications for BCC strategy: corporate partnerships have the potential to scale up initiatives; companies can leverage …

Role Of Advertising Agencies In Behavior Change Communication, Population Council

Reproductive Health

A partner in the Population Council–led Consortium, RK Swamy BBDO, conducted a qualitative study of advertising agencies to document their experiences with regard to planning and implementing behavior change communication (BCC) campaigns on social and health issues for rural populations; explore media planners' perspectives regarding the challenges faced in implementing these campaigns and possible strategies to make them more effective; and understand the role of the Directorate of Advertising and Visual Publicity, the nodal multi-media unit of the Ministry of Information and Broadcasting, Government of India in reaching rural populations with information on government policies and programs. The findings outlined …

Increasing Postpartum Contraception In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess the level of adoption of postpartum contraception for spacing among low parity women, identify the facilitating factors and barriers to the adoption of this target behavior, and identify programmatic and behavior change communications (BCC) initiatives that could accelerate the adoption of postpartum contraception for spacing and improve the service delivery system, if required, to facilitate the process. Barriers included low awareness of consequences of closely spaced births, misconceptions about contraceptive methods, lack of counseling by health workers, reluctance to include husbands, and programmatic emphasis on limiting …

Improving The Health Care Response To Gender-Based Violence: Project Evaluation Report, Meiwita P. Budiharsana, Mai Quoc Tung

Reproductive Health

Consistent with previous studies, this study provides evidence that gender-based violence (GBV) remains a problem in Viet Nam with indications that it may be on the increase. In 2009 the Population Council Viet Nam in collaboration with the Hanoi Health Department, carried out an evaluation among the staff of Duc Giang Hospital to assess the extent to which awareness and perceptions of GBV had changed since a pilot intervention project commenced in 2005. Overall the project has been very effective in raising awareness and willingness to integrate GBV screening in the health services. This report documents the results and lists …

Private Sector's Role In Health Service Provision In Senegal, Population Council

Reproductive Health

In Senegal, private providers are a major source of health services, including contraceptive services, and private sector partnerships are a key component of the Ministry of Health strategy toward achieving national health objectives. This brief reports on SMNI/PF/PALU—a five-year USAID-bilateral project aiming to foster high-quality service delivery, and build strong links between all levels of the health system and communities, including between private and public health sectors. In Senegal, private businesses have hosted innovative advocacy activities, committed to health supplies and information management, and demonstrated a general interest in supporting a collaborative movement toward national health objectives. With private sector’s …

Rôle Du Secteur Privé Dans L'Offre De Services De Santé Au Sénégal, Population Council

Reproductive Health

In Senegal, private providers are a major source of health services, including contraceptive services, and private sector partnerships are a key component of the Ministry of Health strategy toward achieving national health objectives. This brief reports on SMNI/PF/PALU—a five-year USAID-bilateral project aiming to foster high-quality service delivery, and build strong links between all levels of the health system and communities, including between private and public health sectors. In Senegal, private businesses have hosted innovative advocacy activities, committed to health supplies and information management, and demonstrated a general interest in supporting a collaborative movement toward national health objectives. With private sector’s …

Future Demands For Services From Public Health Facilities In Uttar Pradesh, Population Council

Reproductive Health

A Population Council-led consortium in India conducted a study to assess (a) the expected workload of public health facilities, and (b) the extent to which the demand for contraception could be met by the existing health facilities in Uttar Pradesh, following the implementation of behavior change communication (BCC) activities. This policy brief recommends that BCC efforts create demand for services and address perceptions that it is “not necessary” to access health care services. BCC must play a greater role in motivating women to move to facilities not just for institutional delivery but for other services as well. BCC can also …

Increasing The Practice Of Thermal Care To Prevent Newborn Hypothermia: Implications For Behavior Change Communication In Rural Uttar Pradesh, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess current newborn bathing practices and the methods adopted to keep the baby warm immediately after birth; explore the beliefs that guide these customs and practices; identify the barriers and facilitating factors in adopting healthy newborn care practices, such as skin-to-skin contact (STSC); and identify programmatic and behavior change communication (BCC) initiatives that could accelerate the adoption of newborn care practices. Barriers included misconceptions about the consequences of bathing a newborn and a lack of awareness among mothers and health workers about STSC. Facilitating factors included contact …

Health Insurance Patterns Among Latinos In Comparative Perspective, 2004 — 2007, Rachael Varra

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report examines the rates at which the four major racial/ethnic groups in the United States — Latinos, non-Hispanic Whites, non-Hispanic Blacks and Asians — lacked health insurance from 2004- 2006 in the U.S. overall and in the ten states with the largest Latino populations: California, Texas, Florida, New York, Illinois, Arizona, New Jersey, Colorado, New Mexico and Georgia.

Methods: The “lack of insurance data” in this report were derived from Health Statistics Data obtained by the Center for Disease Control from 2004 to 2006. In September 2008 these data became available by race, age and ethnicity/race on a …

Pilot Community-Based Intervention To Address The Needs Of Elderly Caregivers In The Eastern Cape Province, South Africa, Priscilla Reddy, Shegs James, H. Mutumba Bilay-Boon, Eka Esu-Williams, Hena Khan

HIV and AIDS

The HIV epidemic in South Africa has placed a substantial burden on elderly caregivers, mainly women, who are often tasked with caring for their grandchildren who are orphaned and rendered vulnerable by the death or illness of their parents. The Medical Research Council (MRC), Age-in-Action, and the Horizons Program conducted formative research, as described in this research summary, to assess the needs of elderly caregivers in the Eastern Cape Province of South Africa in 2005. The investigations revealed that elderly caregivers faced a number of challenges including difficulty communicating with youth, fears and a sense of hopelessness around matters regarding …

The Afford Health Marketing Initiative In Uganda: Mid-Term Evaluation, Oleksandr Rohozynsky, Christie Billingsley, Annette Bongiovanni

HIV and AIDS

AFFORD is a five-year (2005–10) social marketing initiative financed by the United States Agency for International Development (USAID)/Uganda. It supports the Uganda Ministry of Health’s strategic plan to promote positive health-care-seeking behavior and reduce the shortage of health products and services related to family planning and reproductive health; child health; malaria prevention and treatment; and HIV prevention, care, and treatment. AFFORD seeks to achieve the sustainable marketing of products and services that prevent transmission of HIV, malaria, and diarrheal diseases; to help couples plan their families; and to help people living with HIV enjoy improved quality of life. Target groups …

Final Evaluation Of The Project For Expanding The Role Of Networks Of People Living With Hiv/Aids, Young-Mi Kim, John Lukwago, Stella Neema

HIV and AIDS

In July 2006, the International HIV/AIDS Alliance launched a three-year project on Expanding the Role of Networks of People Living with HIV/AIDS in Uganda. The project, which is funded by the United States Agency for International Development (USAID)/Uganda, sought to increase the involvement of people living with HIV/AIDS (PHA) in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for PHA households. USAID/Uganda commissioned an evaluation of the project’s design, strategies, and performance in order to improve its implementation and learn from its successes and challenges. The study was a cross-sectional descriptive …

Formative Evaluation: Presidential Initiative On Aids Strategy For Communication To Youth, Netsayi N. Mudege, Chi-Chi Undie

HIV and AIDS

HIV prevention programming is increasingly taking place in school settings, which provide an expansive population of young people and offer immense potential for impact on the lives of this target group. The Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) is a school-based program that has sought to address the HIV/AIDS epidemic in Uganda in a holistic manner since 2002, targeting young people, school personnel, parents, and the wider community. A formative evaluation was conducted by the African Population and Health Research Center in February 2009 to provide an understanding of: the extent to which PIASCY is achieving …

The Overlooked Epidemic: Addressing Hiv Prevention And Treatment Among Men Who Have Sex With Men In Sub-Saharan Africa, National Aids Control Council Of Kenya, Population Council

HIV and AIDS

Globally, less than 1 out of 20 men who have sex with men (MSM) has access to HIV prevention and care. UNAIDS has estimated that at least 5 to 10 percent of all HIV infections globally occur through male-to-male sexual activity. In spite of the high risk of HIV infection and evidence of extensive sexual networks, national HIV programs in Africa have been slow to address MSM in prevention and treatment efforts. To address these issues, the Population Council and the National AIDS Control Council of Kenya convened a meeting on May 14–15, 2008. The goals of the meeting were …

Technical Assistance To The Uganda Aids Commission For Operationallisation Of The Performance Monitoring And Management Plan, Frederick Makumbi, Roy Mayega, David Kisitu, Juliet Sekandi, Denis A. Bwesigye, Robert Miller, Sam Kalibala

HIV and AIDS

The Uganda AIDS Commission (UAC) has committed to rolling out and making operational a new National Performance Monitoring and Management Plan (PMMP) to monitor and evaluate the national response to the HIV/AIDS epidemic. The PMMP has at its core the collection and processing of 58 national indicators, 47 district output indicators, and 22 outcome indicators covering prevention, care, treatment, and social support. The rollout is challenging because at least seven organizations must collaborate at the national level, and appropriate staff at the district level need to be in place and trained in new procedures of data collection. In addition, these …

Family Centred Approach For Hiv Services: Pilot Study In South Africa, Meredith Sheehy, Nomtandazo Patricia Mini, Tonicah Maphanga, Scott E. Kellerman

HIV and AIDS

In 2003, UNICEF estimated that nearly 250,000 children were infected with HIV in South Africa. While scale-up of prevention of mother-to-child transmission (PMTCT) programs has improved testing and care for perinatally infected infants, uptake of these services remains low in much of sub-Saharan Africa and few HIV infected children are diagnosed and receive services through PMTCT programs. With support from USAID/PEPFAR, the Horizons Program adapted a family-centered model for children and families in need of broader-reaching HIV diagnostic services in South Africa. The Family Centered Approach (FCA) pilot intervention was designed to expand access to HIV testing for family members …

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Cambodia 2005, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Cambodia 2005” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

Ensuring Education For All In Bihar: Highlighting The Obstacles, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

The extent to which India will be able to successfully harness its demographic dividend depends significantly on the situation of its youth, notably on the levels of education and market-oriented skills they attain. While many states have made progress on the education front, many other states, including Bihar, have lagged behind. Looking at the current educational situation of youth in Bihar, this policy brief argues that significant investments in terms of appropriate policies and programs are required to enable the state to: achieve the Millennium Development Goals of universal primary education and elimination of gender disparity in primary and secondary …

Adolescent Girls In Urban Ethiopia: Vulnerability And Opportunity, Abebaw Ferede, Annabel Erulkar

Poverty, Gender, and Youth

In 2008, the Population Council undertook a survey of out-of-school, adolescent girls (aged 10 to 19) in slum areas of urban Ethiopia—a population that is highly vulnerable to HIV infection. The survey serves as a baseline for HIV prevention programs designed and implemented jointly by the Ministry of Youth and Sports, Regional Bureaus of Youth and Sports, and the Population Council. This study provided valuable direction for programmers interested in supporting adolescent girls, particularly early adolescent (10 to 14 years old) and out-of-school girls who are highly vulnerable and in need of dedicated attention. Special efforts are needed to support …

Hospice Africa Uganda: End-Of-Project Evaluation Of Palliative Care Services, Annette Bongiovanni, Mary Alexis Greenan

HIV and AIDS

Hospice Africa Uganda (HAU) is a nongovernmental organization that provides palliative care services to people living with HIV/AIDS (PHA) and cancer. Based in Kampala, HAU aims to scale-up palliative care within and beyond the nation’s borders. From 2005–08, HAU sought to achieve the following objectives: 1) Increase coverage and scope of palliative care services available to PHA and their families; 2) Train health workers and other HIV/AIDS care providers to integrate pain management, symptom control, and end-of-life care into their existing HIV/AIDS support programs; 3) Build the capacity of families, communities, and community-based organizations in palliative care provision; 4) Integrate …

Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend

Reproductive Health

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from …

Kwazulu-Natal Department Of Health Policy And Guidelines For Integrated Ante And Postnatal Care At District Hospital Community Health Centre And Clinic Level, Population Council

Reproductive Health

A 2006 baseline survey conducted by CARE Kenya indicated that sexual and gender-based violence (SGBV) is widespread throughout Kenya’s North Eastern Province. Other findings revealed that high levels of stigma and gender imbalances are associated with sexual violence and female genital mutilation (FGM) and that a coordinated approach to responding to the service needs of survivors is missing. As noted in this report, there is limited awareness of the legal mechanisms available to survivors. The Population Council’s study in Wajir District ascertained the need for and possible components of an integrated and comprehensive services model that could meet the needs …

Integration Of Services: Making Integrated Services A Reality, Frontiers In Reproductive Health

Reproductive Health

Programs seeking to provide a more comprehensive RH service may establish or strengthen referrals between related yet separately provided services that enable a client to receive the range of needed services. There are two main rationales for integrating services. First, many clients have needs for several services; and second, there is an expectation that providing integrated or linked services can be more efficient programmatically. Little empirical evidence exists to support these underlying rationales, or to guide policies and programs in organizing services effectively and efficiently. Lessons from FRONTIERS have demonstrated not only the demand for multiple services, but also the …

A Religious Oriented Approach To Addressing Female Genital Mutilation/Cutting Among The Somali Community Of Wajir, Kenya, Maryam Sheikh Abdi, Ian Askew

Reproductive Health

The Somali ethnic community, in Kenya as well in Somalia, Djibouti, and Ethiopia, has practiced genital cutting for centuries and the practice appears to have remained largely unchanged. The community practices the severest form of FGM/C, type III or infibulation. The Population Council’s FRONTIERS program, with support from USAID/Kenya, carried out two studies to better understand the practice of FGM/C among the Somalis in North Eastern Province so as to inform the design and implementation of interventions that would encourage abandonment of the practice. Both studies collected data through in-depth interviews and focus group discussions with community and religious leaders, …